掌侧微创手术治疗桡骨远端骨折疗效分析

Analysis of the Effect of Palmar Minimally Invasive Surgery on Distal Radius Fractures

目的比较小切口掌侧入路保留旋前方肌(pronator quadratus,PQ)T型钢板内固定和经Henry入路传统方法内固定治疗桡骨远端骨折的疗效。方法2017年1月至2018年1月,我科将40例桡骨远端骨折患者随机分为微创组(20例)和传统组(20例),分别行小切口掌侧入路保留PQ的T型钢板内固定(微创组),和经Henry入路切断PQ的传统方法内固定(传统组)。比较两组手术前后尺骨茎突高度、掌侧倾斜角度,及切口长度、手术时间、术中出血量。随访1年后,对两组患者的手腕运动功能、握力、腕关节患者自评量表(patient-rated wrist evaluation,PRWE)及视觉疼痛模拟评分(visual analogy score,VAS)进行评估。结果微创组最终入组17例,传统组最终入组15例。两组患者的性别、年龄、骨折分类以及手术时间等差异无统计学意义(P>0.05);但微创组的切口长度短于传统组,术中出血量少于传统组(P<0.001)。两组术前尺骨茎突高度、背侧成角角度、桡侧成角角度无差异(P>0.05),术后微创组的尺骨茎突高度明显短于传统组(P<0.001),而背侧成角角度(P=0.05)、桡侧成角角度(P>0.05)无差异。随访1年,对两组患者的手腕运动功能、握力、PRWE功能评分及VAS疼痛评分进行了评估,结果显示术后1、3月微创组的疼痛更轻,术后3、6月微创组的PRWE评分更低,且微创组的旋转功能优于传统组,存在统计学差异(P<0.05)。结论小切口掌侧入路保留PQ的T型钢板内固定治疗桡骨远端骨折是一种安全可靠的技术,手术微创,疤痕较小,且能恢复良好的腕关节旋转功能。

Objective To introduce and to evaluate the functional results of volar plating of distal radial fractures through a longitudinal minimally invasive approach.Methods From January 2017 to January 2018,40 patients with distal radial fractures were randomly allocated to group A(n=20;8 men,12 women;mean age of 52(23~77)years)and B(n=20;9 men,11 women;mean age of 51(22~78)years),including type A2,A3,C1,and C2 fractures,based on AO Foundation and Orthopedic Trauma Association Classification.Patients in group A were treated through a 1.5~2cm longitudinal incision,and patients in group B were treated through the conventional flexor carpi radialis approach.All fractures were treated with a locking volar plate.The functional results were compared with range of motion,grip and pronation strengths for each fracture type.Results There were 17 cases and 15 cases enrolled in group A and B.There was no significant difference between the two groups in gender,age,fracture classification,injury to operation time,postoperative complications,and operation time(P>0.05).However,the incision length of the minimally invasive group was shorter than that of the traditional group,and the amount of intraoperative bleeding was less than that of the traditional group(P<0.001). There was no difference in the height of ulnar stylo,angle of dorsal angulation and angle of radial angulation between the two groups(P>0.05).The height of ulnar stylo in the minimally invasive group was significantly shorter than that in the traditional group(P<0.001),while there was no difference in the angle of dorsal angulation(P=0.05)and angle of radial angulation(P>0.05).After one year of follow-up,the wrist movement function,grip strength,PRWE and VAS of the two groups were evaluated.The results showed that the pain of the minimally invasive group was lighter 1 and 3 months after operation,and the PRWE score of the minimally invasive group was lower 3 and 6 months after operation,and the rotation strength and function improvement of the minimally invasive group were better than that of the traditional group,with statistical differences(P<0.05).There were no postoperative complications such as incision infection,fever,median nerve injury and radial artery injury in both groups.Conclusions Minimally invasive volar plating of distal radial fractures is a safe and reliable technique,resulting in better rotation function and appearance.