改良Henry入路缝合旋前方肌对桡骨远端骨折功能恢复疗效比较

Comparison of functional recovery of distal radius fracture by suture of pronator muscle through modified Henry approach

目的:探讨桡骨远端骨折改良Henry入路手术治疗中是否缝合旋前方肌对术后前臂功能的影响。方法:自2018年1月至2020年12月采用改良Henry入路切开复位锁定钢板内固定治疗桡骨远端骨折患者220例,按照缝合方法不同分为两组,术中缝合组112例,男35例,女77例;年龄37~65(48.5±7.4)岁;骨折AO分型,B型46例,C型66例;骨折复位锁定钢板固定后将切开旋前方肌予以缝合。不缝合组108例,男32例,女76例;年龄34~67(47.6±7.8)岁;骨折AO分型B型41例,C型67例;骨折复位锁定钢板固定后对切开旋前方肌不予缝合,原位铺于钢板表面。分别于术后6周、6个月比较两组腕关节活动范围(旋前、旋后、掌倾、背伸),肩臂手功能障碍评分量表(disability of arm shoulder and hand,DASH)评分和视觉模拟评分(visual analogue scale,VAS)。结果:220例患者获得随访,时间6~18(8.5±1.3)个月。术后6周,两组腕关节活动范围、DASH评分比较差异无统计学意义(P>0.05);术后6周术中缝合组VAS评分(2.6±1.2)分,与不缝合组(5.8±2.3)分比较差异有统计学意义(P<0.05)。术后6个月两组腕关节活动范围、DASH评分、VAS评分比较差异无统计学意义(P>0.05)。结论:改良Henry入路缝合旋前方肌在术后腕关节活动范围、上肢功能近期无明显优势,但术中缝合旋前方肌能减少早期术后疼痛,建议术中应缝合旋前方肌。

Objective:To investigate the effect of suture of pronator muscle on forearm function after modified Henry approach for distal radius fractures.Methods:from January 2018 to December 2020,220 patients with distal radius fractures were treated with open reduction and locking plate internal fixation through the modified Henry approach.They were divided into two groups according to different suture methods.There were 112 cases in the intraoperative suture group,including 35 males and 77 females;The age ranged from 37 to 65(48.5±7.4)years;AO classification of fracture,46 cases of type B and 66 cases of type C;After fracture reduction and locking plate fixation,the pronator muscle was opened and sutured.There were 108 cases in the non suture group,32 males and 76 females;The age ranged from 34 to 67(47.6±7.8)years;There were 41 cases of fracture type B and 67 cases of fracture type C;After fracture reduction and locking plate fixation,the open pronator muscle was not sutured,and it was laid on the surface of the plate in situ.The range of wrist motion(pronation,supination,palmar inclination and dorsiflexion),the score of disability of arm shoulder and hand dash and visual analog scale(VAS)were compared between the two groups at 6 weeks and 6 months after operation.Results:All 220 patients were followed up for 6 to 18(8.5±1.3)months.There was no significant difference in the range of motion and DASH score of forearm and wrist between the two groups 6 weeks after operation(P>0.05);There was significant difference in VAS score between suture group(2.6±1.2)and non suture group(5.8±2.3)(P<0.05).Six months after operation,there was no significant difference in the range of motion,DASH score and VAS score of forearm and wrist between the two groups(P>0.05).Conclusion:The modified Henry approach has no obvious advantages in the range of wrist movement and upper limb function,but the intraoperative suture of pronator can reduce the early postoperative pain.It is suggested that the pronator should be sutured during the operation.