两种经皮微创保留旋前方肌钢板内固定治疗桡骨远端骨折的疗效比较

A comparison of two kinds of percutaneous minimally invasive plate fixation sparing pronator quadratus for treatment of distal radius fractures

目的比较常规保留旋前方肌经皮微创钢板固定与3点定位技术保留旋前方肌经皮微创掌侧锁定钢板内固定治疗桡骨远端骨折的临床疗效。方法回顾性分析2015年1月至2017年12月采用保留旋前方肌经皮微创术治疗的50例桡骨远端骨折患者资料。男24例,女26例;年龄21~71岁。根据治疗方式不同分为2组:采用常规微创治疗25例(常规组),采用3点定位微创治疗25例(定位组);记录并比较两组术中透视旋前方肌下钢板调放次数、骨折愈合时间等;比较两组患者术后第1、3、7天的腕关节疼痛视觉模拟评分(VAS)、术后3个月的腕关节屈伸及前臂旋转度、Gartland-Werley评分等。结果常规组与定位组患者的术前一般资料比较差异均无统计学意义(P>0.05),有可比性;常规组旋前方肌下钢板调放次数(3.4±0.5)次高于定位组(1.1±0.3)次,差异有统计学意义(P<0.05)。常规组术后第1、3、7天腕关节疼痛VAS评分均高于定位组,差异均有统计学意义(P<0.05);术后3个月常规组与定位组腕关节旋前范围分别为(76.6°±1.9°)、(82.3°±2.0°),Gartland-Werley评分分别为(3.4±0.5)、(1.9±0.2)分,以上项目两组间比较差异均有统计学意义(P<0.05)。结论较常规微创治疗技术,3点定位微创治疗技术保留旋前方肌治疗桡骨远端骨折能最小限度损伤旋前方肌,具有更微创、更少的术后早期疼痛症状、更快的功能恢复等特点,值得临床推广。

Objective To compare the conventional percutaneous minimally invasive plate fixation sparing pronator quadratus versus the 3-point positioning percutaneous minimally invasive palmar locking plate fixation sparing pronator quadratus for distal radial fractures.Methods Between January 2015 and December 2017,50 patients with distal radius fracture were treated surgically at Department of Orthopaedics,The Second Hospital of Fuzhou by percutaneous minimally invasive plate fixation sparing pronator quadratus.They were 24 males and 26 females,aged from 21 to 71 years.Conventional percutaneous minimally invasive plate fixation was conducted for 25 patients and 3-point positioning minimally invasive plate fixation for the other 25 patients.The 2 groups were compared in terms of fluoroscopic adjustments of the plate under the pronator quadratus,fracture healing time,visual analogue scale(VAS)on days 1,3 and 7 postoperation,and wrist flexion and extension,forearm rotation and upper limb function by Disabilities of the Arm,Shoulder and Hand(DASH)scores and Gartland-Werley scores at 3 months postoperation.Results There was no significant difference in the general data between the 2 groups,showing comparability between groups(P>0.05).The fluoroscopic adjustments of the plate under the pronator quadratus for the conventional group(3.4±0.5)were significantly more than for the 3-point positioning group(1.1±0.3)(P<0.05).The VAS scores on days 1,3 and 7 postoperation for the conventional group were significantly higher than for the 3-point positioning group(P<0.05).At 3 months postoperation,the wrist pronation was respectively 76.6°±1.9°and 82.3°±2.0°,and the Gartland-Werley scores were respectively 3.4±0.5 and 1.9±0.2 for the conventional and 3-point positioning groups,showing significant differences between the 2 groups(P<0.05).Conclusions In the treatment of distal radial fractures,compared with conventional percutaneous minimally invasive plate fixation,the 3-point positioning minimally invasive plate fixation sparing pronator quadratus may minimize the damage to the pronator quadratus,be more minimally invasive,and lead to less early postoperative pain and faster functional recovery.