基于浮筏撬拨技术的桡骨远端骨折切开复位内固定的术式设计及运用

Design and application of open reduction and internal fixation for distal radius fracture based on floating-raft prying technique

目的对于移位的不稳定桡骨远端骨折患者,设计规范程式化的掌侧接骨板内固定术式,探索新术式的临床疗效。方法选择桡骨远端骨折患者共48例,其中男性21例,女性27例;年龄18~65岁,平均年龄63.5岁。随机分为两组,即治疗组和对照组。治疗组患者23例,其中男性10例,女性13例;年龄58~80岁,平均年龄63.2岁。对照组患者25例,男性11例,女性14例;年龄57~81岁,平均年龄63.8岁。治疗组借助浮筏撬拨技术复位、围旋前方肌双窗口技术暴露和"鱼簖"技术定位实现接骨板掌侧内固定术;对照组使用传统切开复位内固定术治疗。观察两组患者的手术时间和腕关节功能。结果治疗组手术时间较对照组缩短[(39.12±3.04) min vs(46.52±3.53) min;t=1.762,P <0.05]。术后3个月,治疗组腕关节功能减损值为8.9°,对照组腕关节功能减损值为12.7°;治疗组优于对照组,差异有统计学意义(χ^2=42.12,P <0.05)。结论基于浮筏撬拨技术的桡骨远端骨折切开复位内固定的术式可以实现程式化,缩短手术时间,维护腕部和前臂旋转功能,值得进一步推广。

Objective To design specification of stylized pelvic plate fixation for exploring clinical efficacy of new procedure in displaced unstable distal radius fracture patients. Methods A total of 48 patients with distal radius fracture were enrolled,which included 21 males and 27 females, aged 18-65 years old with mean age of 63.5 years old. All of them were randomly divided into treatment group(n = 23, 10 males and 13 females;aged 58-80 years old with mean age of 63.2 years old) and control group(n = 25, 11 males and 14 females;aged 57-81 years old with mean age of 63.8 years old). The treatment group performed pelvic internal fixation by floating-raft prying technology, circumferential anterior muscle double window technique exposure and "fishing rod" technology. The control group performed traditional open reduction and internal fixation treatment. The operation time and wrist function of 2 groups were observed. Results The operation time of treatment group was shorter than that of control group[(39.12 ± 3.04) minutes vs(46.52 ± 3.53) minutes;t = 1.762, P < 0.05]. Three-month post treatment, the impairment value of wrist joint function was 8.9° in treatment group, which was statistically significantly better than that in control group(12.7°)(χ^2= 42.12, P < 0.05). Conclusion It is demonstrated that open reduction and internal fixation for distal radius fracture based on floating-raft prying technology could shorten operation time and maintain rotation function of wrist and forearm, which is worth promoting.