保留旋前方肌改良Henry入路掌侧钢板内固定术治疗老年桡骨远端骨折患者的效果

Effects of pronator quadratus muscle-preserving volar plate internal fixation through modified Henry approach in treatment of elderly patients with distal fractures of radius

目的:观察保留旋前方肌改良Henry入路掌侧钢板内固定术治疗老年桡骨远端骨折患者的效果。方法:选取2018年5月至2020年11月80例老年桡骨远端骨折患者进行前瞻性研究,以抽签法随机分为对照组和观察组各40例。对照组采用常规Henry入路掌侧钢板内固定术治疗,观察组采用保留旋前方肌改良Henry入路掌侧钢板内固定术治疗,比较两组术后疼痛[视觉模拟评分法(VAS)]评分、前臂旋转角度、骨折愈合评分、术后腕关节活动度、上肢功能[上肢功能障碍评定量表(DASH)]评分、日常活动能力[Barthel指数]评分、治疗优良率和术后1个月并发症发生率。结果:术后2、3周,观察组VAS评分均低于对照组,前臂旋转角度大于对照组,差异有统计学意义(P<0.05);术后2周,观察组骨折愈合评分高于对照组,差异有统计学意义(P<0.05);术后3周,观察屈曲活动度、背伸活动度、尺偏活动度均大于对照组,差异有统计学意义(P<0.05);术后2、3周,观察组DASH评分低于对照组,Barthel指数评分高于对照组,差异均有统计学意义(P<0.05);观察组治疗优良率为87.50%(35/40),高于对照组的62.50%(25/40),差异有统计学意义(P<0.05);观察组并发症发生率为7.50%(3/40),低于对照组的25.00%(10/40),差异有统计学意义(P<0.05)。结论:保留旋前方肌改良Henry入路掌侧钢板内固定术治疗老年桡骨远端骨折患者可降低疼痛评分、DASH评分和并发症发生率,提高治疗优良率、前臂旋转角度、骨折愈合评分、Barthel指数评分和术后腕关节活动度,效果优于常规Henry入路掌侧钢板内固定术治疗。

Objective:To observe effects of pronator quadratus muscle-preserving volar plate internal fixation through modified Henry approach in treatment of elderly patients with distal fractures of radius.Methods:80 elderly patients with distal fractures of radius were selected for the prospective study from May 2018 to November 2020,and were divided into control group and observation group by the lottery method,40 cases in each group.The control group was treated with volar plate internal fixation through conventional Henry approach,while the observation group was treated with the pronator quadratus muscle-preserving volar plate internal fixation through the modified Henry approach.The postoperative pain[visual analogue scale(VAS)]score,the forearm rotation angle,the fracture healing score,the postoperative wrist joint range of motion,the upper limb function[disabilities of the arm,shoulder and hand(DASH)]score,the activities of daily living(Barthel index)score,the excellent and good rate of treatment,and the 1 month postoperative complication rate were compared between the two groups.Results:2 and 3 weeks after the surgery,the VAS scores of the observation group were lower than those of the control group,the forearm rotation angles were greater than those of the control group,and the differences were statistically significant(P<0.05).2 weeks after the surgery,the fracture healing score of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).3 weeks after the surgery,the flexion range of motion,the dorsal extension range of motion and the ulnar deviation range of motion of the observation group were greater than those of the control group,and the differences were statistically significant(P<0.05).2 and 3 weeks after the surgery,the DASH scores of the observation group were lower than those of the control group,the Barthel index scores were higher than those of the control group,and the differences were statistically significant(P<0.05).The excellent and good rate of treatment in the observation group was 87.50%(35/40),which was higher than the control group of 62.50%(25/40),and the difference was statistically significant(P<0.05).Further,the incidence of complications in the observation group was 7.50%(3/40),which was lower than 25.00%(10/40)in the control group,and the difference was statistically significant(P<0.05).Conclusions:The pronator quadratus muscle-preserving volar plate internal fixation through the modified Henry approach for the elderly patients with distal fractures of radius can reduce the pain score,the DASH score and the complication rate,and improve the excellent and good rate of treatment,the forearm rotation angle,the fracture healing score and the Barthel index score.Moreover,it is superior to the volar plate internal fixation through the conventional Henry approach.