尺桡双骨折早期筋膜室症两种减压内固定比较

Comparison of two kinds of decompression and internal fixation for radioulnar fractures accompanied with early-stage compartment syndrome

[目的]探讨两种减压固定治疗尺桡骨双骨折并发早期骨筋膜室综合征的疗效。[方法] 2015年3月—2020年6月,手术治疗尺桡骨双骨折合并早期骨筋膜室综合征患者60例。根据医患沟通结果,29例采用减压双钢板固定(双钢板组),31例采用减压桡侧钢板和尺侧髓内针固定(混合组)。比较两组的临床及影像学资料。[结果]混合组患者切口长度、手术时间、骨折端骨膜剥离面积、术中出血量、术后引流量、创面闭合时间和住院时间均显著优于双钢板组(P<0.05)。术后随时间推移,两组VAS评分均显著降低(P<0.05),术后3 d及5 d,混合组的VAS评分均显著优于双钢板组(P<0.05)。随访时间平均(13.18±1.63)个月,术后6个月,混合组在前臂旋转ROM和DASH评分均显著优于双钢板组(P<0.05)。影像方面,混合组影像骨折愈合显著早于双钢板组(P<0.05)。[结论]与双钢板相比,混合固定疗法治疗尺桡骨双骨折合并早期骨筋膜室综合征效果更优。

[Objective] To explore the short-term outcomes of two kinds of decompression and fixation for radioulnar fractures complicated with early-stage compartment syndrome. [Methods] From March 2015 to June 2020, 60 patients underwent surgical treatment for radioulnar fractures complicated with early-stage compartment syndrome. According to doctor-patient communication, 29 patients received decompression combined with double plate fixation(DPF group), while the remaining 31 patients received decompression combined with radial plate and ulnar intramedullary nail fixation(the hybrid group). The clinical and imaging data of the two groups were compared. [Results] The hybrid group proved significantly superior to the DPF in terms of incision length, operation time, periosteal dissection area, intraoperative blood loss, postoperative drainage, wound closure time and hospital stay(P<0.05). The VAS scores significantly decreased over time at early stage after surgery in both groups(P<0.05), which in the hybrid group were significantly better than those of the DPF group at3 and 5 days after surgery(P<0.05). The patients were followed up for(13.18±1.63) months on an average, and the hybrid group was significantly superior to the DPF group in terms of forearm pronation-supernation range of motion(ROM) and DASH scores at 6 months after surgery(P<0.05). Radiographically, the hybrid group got fracture healing significantly earlier than the DPF group(P<0.05). [Conclusion] Compared with double plate, the hybrid fixation is more effective for treatment of radioulnar fractures accompanied with early-stage compartment syndrome.