不同保留旋前方肌的内固定方法对桡骨远端不稳定骨折患者腕关节功能的影响

Effects of Different Internal Fixation Methods of Retaining Pronator Quadratus on the Wrist Joint Function of Patients with Unstable Distal Radius Fractures

目的:探讨不同保留旋前方肌的内固定方法对桡骨远端不稳定骨折患者腕关节功能的影响。方法:2015年9月~2020年9月收治的桡骨远端不稳定骨折患者82例根据不同保留旋前方肌的内固定方法分为观察组(改良式Henry入路旋前方肌下置钢板,n=35)和对照组(Henry入路旋前方肌下骨膜外置插钢板,n=47)。两组术后均随访1年,统计比较两组手术时间、术中出血量、术后住院时间、骨折愈合时间、术后随访1年的腕关节活动度与Gartland-Werley评分及并发症发生率。结果:观察组手术时间、骨折愈合时间均短于对照组,术中出血量低于对照组,术后随访1年的背伸度、掌屈度、桡偏度、尺偏度、旋后度、旋前度等腕关节活动度均高于对照组,观察组同期Gartland-Werley评分低于对照组(P<0.05)。两组术后住院时间比较差异无统计学意义(P>0.05)。两组均无并发症发生,治疗安全性良好。结论:改良式Henry入路旋前方肌下置钢板可更有效促进桡骨远端不稳定骨折愈合及患者腕关节功能恢复,且安全可靠。

Objective:To investigate the effect of different internal fixation methods of retaining pronator quadratus on the wrist joint function of patients with unstable distal radius fractures.Methods:82 patients with unstable distal radius fractures admitted to a hospital from September 2015 to September 2020 were divided into observation group(placement of plate under the pronator quadratus by modified Henry approach,n=35)and control group(periosteum external placement of plate under the pronator quadratus by Henry approach,n=47)according to different internal fixation methods of retaining the pronator quadratus.Both groups were followed up for 1 year after operation.The operation time,intraoperative blood loss,postoperative hospital stay time,fracture healing time,the wrist range of motion and Gartland-Werley score during the 1-year follow-up,and the incidence of complications between the two groups were statistically compared.Results:The operation time and the fracture healing time of the observation group were shorter than those of the control group,the intraoperative blood loss of the observation group was lower than that of the control group,the wrist joint mobility such as back extension,palm extension,radial extension,ulnar extension,supination extension and pronation extension followed up for 1 year after the operation of the observation group were higher than those of the control group,while the Gartland-Werley score of the observation group was lower than that of the control group during the same period(P<0.05).There was no significant difference in postoperative hospital stay time between the two groups(P>0.05).No complications occurred in the two groups,and the treatment safety was good.Conclusion:Placement of plate under the pronator quadratus by modified Henry approach can more effectively promote the healing of unstable distal radius fractures and the recovery of the patient's wrist joint function,which is safe and reliable.