经掌侧Henry入路植入T型锁定钛板治疗桡骨远端C型骨折的早期随访研究

Short-term follow up of C type comminuted fracture of distal radius treated by implantation of T-type locking titanium plate via volar Henry approach

背景:采用单纯手法闭合复位和石膏外固定治疗桡骨远端C型骨折常因对位对线不稳定、固定不牢固等原因引起创伤性关节炎、关节僵痛、顽固性腕关节疼痛等并发症。目的:探讨经掌侧Henry入路植入T型锁定钛板治疗桡骨远端C型骨折的早期随访结果。方法:回顾性分析2015年6月至2017年4月我院收治的96例桡骨远端C型骨折患者的临床资料并分为两组:对照组48例行外固定架固定术治疗,观察组48例采用掌侧Henry入路植入T型锁定钛板治疗。每例病例随访1年,评价两组患者腕关节功能、术后并发症、术后掌倾角和尺偏角、桡骨长度维持、骨折愈合时间等指标,并进行统计分析。结果:观察组术后掌倾角(11.2°±2.5°vs 9.4°±2.2°)和尺偏角(22.3°±4.4,vs 18.6°±4.7°)高于对照组,骨折愈合时间[(63.9±15.3)d vs(91.3±24.2)d]及桡骨远端长度丧失值[(0.9±0.4)mm vs(2.6±0.6)mm]低于对照组;观察组腕关节功能优良率显著高于对照组(93.8%vs70.8%),并发症总发生率(8.3%vs 22.9%)低于对照组(均P<0.05)。结论:经掌侧Henry入路植入T型锁定钛板治疗桡骨远端C型骨折可有效维持患者术后桡骨远端长度,改善腕关节活动度及功能,且安全性良好,早期随访结果满意。

Background: The treatment of comminuted distal radius fracture of type C with closed reduction and plaster external fixation often causes complications such as traumatic arthritis, joint stiffness and intractable wrist pain due to unstable alignment and unstable fixation. Objective: To investigate the short-term outcomes of C type comminuted fracture of distal radius treated by T-type locking titanium plate via the volar Henry approach. Methods: The clinical data of 96 patients with C type comminuted distal radius fractures admitted to our hospital from June 2015 to April 2017 were retrospectively analyzed. 48 patients taking external fixator were included in the control group and 48 patients who underwent T-type locking titanium plate implantation via volar Henry approach were included in the observation group. The patients were followed up for one year.Wrist function, postoperative complications, postoperative radial and ulnar inclination, radius length maintenance and fracture healing time were evaluated and compared between the two groups. Results: After the operation, the radial incline(11.2°±2.5°vs 9.4°±2.2°) and ulnar inclination(22.3°±4.4° vs 18.6°±4.7°) as well as excellent and good rate of wrist joint function(93.8%vs70.8%) were significantly higher,and fracture healing time([63.9±15.3] d vs [91.3±24.2] d), loss of distal radius length([0.9±0.4] mm vs [2.6±0.6] mm) and overall incidence of complications(8.3% vs 22.9%) were significantly lower in the observation group than in the control group(all P<0.05). Conclusions: The treatment of C type comminuted fracture of distal radius by Ttype locking titanium plate implantation via volar Henry approach is effective on maintaining the postoperative distal radius length and improving the range of motion and function of wrist joint, which is also safe and has satisfactory short-term outcomes.