改良掌侧入路掌侧锁定钢板治疗桡骨远端骨折的疗效

The volaRlocking plate with modified volaRapproach foRtreatment of distal radius fractures

目的探讨改良掌侧入路(Henry入路)掌侧锁定钢板治疗桡骨远端骨折的临床疗效。方法采用改良Henry入路掌侧锁定钢板治疗170例桡骨远端骨折患者。记录末次随访时患者腕关节活动度、前臂旋转度、影像学指标、疼痛VAS评分、握力等情况,采用Quick DASH评分、PRWE评分、Mayo评分评价疗效。结果患者均获得随访,时间12~36个月。末次随访时,腕关节活动度:背伸45°~70°,掌屈35°~65°,桡偏25°~30°,尺偏30°~45°;前臂旋转度:旋前80°~95°,旋后75°~95°;影像学指标:掌倾角5°~20°,尺偏角15°~30°;疼痛VAS评分0~3分,握力13~45 kg,Quick DASH评分0~29分,PRWE评分0~26分,Mayo评分70~99分。末次随访时,腕关节尺偏、前臂旋后、尺偏角、握力方面<65岁年龄段优于≥65岁年龄段(P<0.05);腕关节背伸、腕关节掌屈、腕关节桡偏、前臂旋前、掌倾角、疼痛VAS评分、Quick DASH评分、PRWE评分和Mayo评分方面两年龄段比较差异均无统计学意义(P>0.05)。术后出现26例并发症,其中10例腕管综合征,4例螺钉超过腕关节面,2例伸肌腱刺激,2例正中神经激惹,1例腕关节切口浅表感染,1例拇长伸肌腱断裂,6例切口区遗留疼痛。结论改良Henry入路掌侧锁定钢板治疗桡骨远端骨折临床疗效良好。

Objective To investigate the clinical effect of volaRlocking plate in the treatment of distal radius fracture via modified volaRapproach(Henry approach).Methods The 170 patients with distal radius fractures were treated with modified Henry approach and volaRlocking plate.Wrist range of motion,forearm rotation range,imaging indicators,pain VAS and grip strength were recorded at the last follow-up,and the efficacy was evaluated by Quick DASH score,PRWE score and Mayo score.Results All patients were followed up foR12~36 months.At the last follow-up,the range of motion of wrist was dorsiflexion with 45°~70°,palm flexion with 35°~65°,radial deviation 25°~30°,ulnaRdeviation 30°~45°;forearm rotation range:pronation with 80°~95°,supination with 75°~95°;imaging indicators:palmaRinclination was 5°~20°,ulnaRdeviation 15°~30°;pain VAS was 0~3 points,grip strength was 13~45 kg,Quick DASH score was 0~29 scores,PRWE score was 0~26 scores,Mayo score was 70~99 scores.At the last follow-up,the ulnaRdeviation of wrist joint,forearm supination,ulnaRdeviation and grip strength of<65 years old age group were betteRthan those of≥65 years old age group(P<0.05).There were no significant differences in dorsiflexion,palm flexion,radial deviation of the wrist joint,and forearm pronation,palm inclination,pain VAS,Quick DASH score,PRWE scores and Mayo scores between the two ages(P>0.05).Postoperative complications occurred in 26 cases,including 10 cases of carpal tunnel syndrome,4 cases of screws exceeding the wrist joint surface,2 cases of extensoRtendon stimulation,2 cases of median nerve irritation,superficial infection in 1 case,rupture of extensoRhallucis longus tendon in 1 case,and residual pain in 6 cases.Conclusions The modified Henry approach and volaRlocking plate can achieve good curative effect in the treatment of distal radius fracture.