背掌侧入路与掌侧入路内固定治疗桡骨远端骨折效果分析

Analysis of the Effect of Internal Fixation in the Treatment of Distal Radius Fracture by the Dorsal Palmar Approach and Palmar Approach

目的:探讨应用背掌侧双切口入路内固定治疗及掌侧单切口入路内固定治疗桡骨远端粉碎性骨折(AO分型C型)的临床疗效,并进行分析对比。方法:对笔者所在医院于2016年1月-2018年8月收治的45例桡骨远端粉碎性骨折患者(AO分型C型,无开放性损伤),根据手术入路方式不同进行分组(背掌侧入路组与掌侧入路组),通过观察手术治疗前后的各项客观指标,如骨折愈合时间、掌倾角、尺偏角、桡骨高度、腕关节功能(PRWE评分)和术中操作情况如手术时间、出血量等来进行统计分析对比。结果:本组45例术后随访12~18个月,平均14个月。术后两组病例掌倾角、尺偏角、桡骨高度、腕关节功能评分均较术前有改善,两组病例在腕关节功能评分方面差异无统计学意义(P>0.05),在术中操作情况如手术时间、出血量及术后掌倾角、尺偏角、桡骨高度方面差异有统计学意义(P<0.05),掌侧入路组手术时间、出血量较背掌侧入路组少,掌倾角、尺偏角、桡骨高度维持方面背掌侧入路组较掌侧入路组佳。结论:采用经背掌侧入路,手术时间及出血量要多于掌侧入路组,掌倾角、尺偏角、桡骨高度维持方面背掌侧入路组较掌侧入路组佳,背掌侧入路组腕关节功能评分同掌侧入路组无明显差异。

Objective:To investigate and compare the clinical efficacy of dorsal palmar double incision internal fixation and single incision internal fixation in the treatment of comminuted distal radius fracture(AO type C).Method:In our hospital from January 2016 to August 2018 a total of 45 cases of comminuted distal radius fractures(AO type C,not open),according to the s urgical approach in different way were divided into back the vo lar approach group and the volar approach group.By observing the operation of the objective indicators before and after the treatment such as:fracture healing time,palm angle,ulnar angle,radial height,wrist joint function(PRWE score)and intraoperative operating conditions such as operation time,blood loss,etc.to analyze and compare.Result:This group of 45 cases of postoperative follow-up of 12-18 months,an average of 14 months.Two groups of cases of postoperative palm angle,ulnar angle,radial height,wrist joint function score than preoperative have improved,two groups of cases had no significant statistical differences in terms of wrist joint function score(P>0.05).In intraoperative operating conditions such as operation time,blood loss and postoperative palm obliquity,ulnar angle,radial height had statistical significant(P<0.05).Volar approach group of the operative time,blood loss were relatively less back volar approach group,palm angle,ulnar angle and radial height of back volar approach group were better than volar approach group.Conclusion:The operation time and blood loss of the group using the dorsal palmar approach were more than that of the palmar approach,and the palmar approach was better in terms of maintaining the palmar inclination angle,ulnar angle and radius height.There was no significant difference in the carpal function score between the dorsal palmar approach group and the palmar approach group.