桡侧腕屈肌腱入路与直接掌侧入路切开复位内固定对桡骨远端骨折患者腕关节功能及创伤反应程度的影响

Effects of open reduction and internal fixation through radial wrist flexor tendon approach and direct volar approach on wrist function and degree of trauma response in patients with distal radius fractures

目的探讨桡侧腕屈肌腱入路与直接掌侧入路切开复位内固定对桡骨远端骨折患者腕关节功能及创伤反应程度的影响。方法选取2017年10月至2019年10月收治的40例桡骨远端骨折患者为研究对象,根据手术方式不同将其分为A组(20例)和B组(20例)。A组采用桡侧腕屈肌腱入路切开复位内固定治疗,B组采用直接掌侧入路切开复位内固定治疗。比较两组患者的腕关节活动范围、腕关节功能评分、炎症因子水平、疼痛介质水平。结果术后3、6个月,A组的腕关节活动范围大于B组,差异具有统计学意义(P<0.05);术后12个月,两组的腕关节活动范围无显著差异(P>0.05)。术前、术后12个月,两组的腕关节功能评分无显著差异(P>0.05);术后3、6个月,A组的腕关节功能评分低于B组,差异具有统计学意义(P<0.05)。术前,两组的IL-6、IL-8及CRP水平无显著差异(P>0.05);术后1周,A组的IL-6、IL-8及CRP水平低于B组,差异具有统计学意义(P<0.05)。术前,两组的SP、5-HT及PGE_(2)水平无显著差异(P>0.05);术后1周,A组的SP、5-HT及PGE_(2)水平低于B组,差异具有统计学意义(P<0.05)。结论临床采用桡侧腕屈肌腱入路与直接掌侧入路切开复位内固定治疗桡骨远端骨折均能取得理想的远期效果,但桡侧腕屈肌腱入路能加快腕关节功能恢复,促进患者创伤反应程度减轻。

Objective To investigate the effects of open reduction and internal fixation through radial wrist flexor tendon approach and direct volar approach on wrist function and degree of trauma response in patients with distal radius fractures.Methods A total of 40 patients with distal radius fractures treated from October 2017 to October 2019 were selected as the research objects.The patients were divided into group A(20 cases) and group B(20 cases) according to the different surgical methods.The group A was treated with open reduction and internal fixation through radial wrist flexor tendon approach,and the group B was treated with open reduction and internal fixation through direct volar approach.The range of motion of wrist,wrist function score,the levels of inflammatory factors and pain mediators were compared between the two groups.Results At 3 and 6 months after operation,the range of motion of wrist in the group A was higher than that in the group B,and the difference was statistically significant(P<0.05);at 12 months after operation,there was no significant difference in the range of motion of wrist between the two groups(P >0.05).There was no significant difference in wrist function score between the two groups before and 12 months after operation(P>0.05);at 3 and 6 months after operation,the wrist function score in the group A was lower than that in the group B,and the difference was statistically significant(P<0.05).Before operation,there were no significant differences in the levels of IL-6,IL-8 and CRP between the two groups(P>0.05);one week after operation,the levels of IL-6,IL-8 and CRP in the group A were lower than those in the group B,and the differences were statistically significant(P<0.05).Before operation,there were no significant differences in the levels of SP,5-HT and PGE_(2) between the two groups(P >0.05);one week after operation,the levels of SP,5-HT and PGE_(2) in the group A were lower than those in the group B,and the differences were statistically significant(P<0.05).Conclusion In clinical treatment of distal radius fractures,open reduction and internal fixation through radial wrist flexor tendon approach and direct volar approach can achieve ideal long-term results,but radial wrist flexor tendon approach can accelerate the recovery of wrist function and reduce the degree of trauma response.