掌侧入路和背侧入路切开复位内固定术治疗C型桡骨远端骨折的疗效和安全性比较

Efficacy and safety of open reduction and internal fixation through volar approach and dorsal approach on type C distal radius fracture

目的比较掌侧入路和背侧入路切开复位内固定术治疗C型桡骨远端骨折的疗效和安全性。方法回顾性纳入2017年1月至2020年12月河南大学附属郑州颐和医院收治的68例C型桡骨远端骨折患者的临床资料,根据切开复位内固定术的入路方式将其分为掌侧入路组(34例)和背侧入路组(34例)。比较两组术中出血量、手术时间和骨折愈合时间、术后(1周、1个月、3个月)内固定效果、术后1年腕关节功能恢复情况、术后并发症发生率。结果掌侧入路组术中出血量少于背侧入路组(t=-10.274,P<0.05),手术时间、骨折愈合时间短于背侧入路组(t=-9.246、-6.858,P<0.05)。两组术后同时间点的掌倾角、桡骨高度、尺倾角比较,差异未见统计学意义(P>0.05)。术后1年,两组患侧腕关节功能优良率比较差异未见统计学意义(χ2=2.378,P=0.123)。掌侧入路组患者术后并发症发生率(5.88%,2/34)低于背侧入路组(26.47%,9/34),P<0.05。结论背侧入路与掌侧入路切开复位内固定术治疗C型桡骨远端骨折均具有较好的临床疗效和腕关节功能改善效果,但掌侧入路术中出血量更少,手术时间和骨折愈合时间更短,并发症发生率更低,安全性更高,更有利于手术预后。

Objective To investigate the efficacy and safety of open reduction and internal fixation through volar approach and dorsal approach on type C distal radius fracture.Methods The clinical data of 68 patients with type C distal radius fractures admitted to Zhengzhou Yihe Hospital Affiliated to Henan University from January 2017 to December 2020 were retrospectively included,and they were divided into volar approach group(34 cases)and dorsal approach group(34 cases)according to the approaches of open reduction and internal fixation.The intraoperative blood loss,operative time and fracture healing time,postoperative(1 week,1 month,3 months)internal fixation effect,1-year postoperative wrist joint function recovery,and postoperative complication rates were compared between the two groups.Results The intraoperative blood loss in the volar approach group was less than that in the dorsal approach group(t=-10.274,P<0.05),the operation time and fracture healing time were shorter than those of the dorsal approach group(t=-9.246、-6.858,P<0.05).There was no significant difference in palmar inclination,radial height and ulnar inclination between the two groups at the same time point after operation(P>0.05).One year after operation,there was no significant difference in the excellent and good rate of wrist joint function between the two groups(χ2=2.378,P=0.123).The incidence of postoperative complications in the volar approach group(5.88%,2/34)was lower than that in the dorsal approach group(26.47%,9/34),P<0.05.Conclusions Both dorsal approach and volar approach open reduction and internal fixation for the treatment of type C distal radius fractures have good clinical efficacy,and can improve wrist joint function.However,the volar approach has less blood loss,shorter operation time and fracture healing time,lower complication rate,higher safety,and better prognosis.