保留旋前方肌钢板治疗桡骨远端骨折的疗效

Treatment of distal radius fractures using plate with anterior rotator muscle preservation

目的:比较微创掌侧入路保留旋前方肌与切开旋前方肌锁定钢板治疗桡骨远端骨折的疗效分析。方法:选取就诊的桡骨远端骨折患者60例,随即分为观察组与对照组各30例。观察组予以微创切口保留旋前方肌复位锁定钢板内固定治疗,对照组予以切开旋前方肌复位锁定钢板内固定治疗。比较两组手术切口长度、手术时间、术中出血量、骨折临床愈合时间;标准正侧位片术前、术后两组掌倾角、尺偏角、桡骨短缩程度;两组术后2 w、6 w、12 w、24 w的视觉疼痛模拟量表(VAS)评分;两组术后第1个月、第3个月前臂旋转、腕关节功能活动度数;两组术后并发症发生情况:骨筋膜室综合征,血管、神经损伤,感染情况。结果:两组年龄、性别、患肢分布比较,差异无统计学意义(P>0.05)。两组骨折分型分布差异无统计学意义(P>0.05)。观察组切口长度明显小于对照组,手术时间大于对照组,但都在一个止血带时程之内;观察组术中出血量小于对照组,骨折临床愈合时间小于对照组,差异均有统计学意义(均P<0.05)。统一的标准正侧位片:术前、术后两组掌倾角、尺偏角、桡骨短缩差异无统计学意义(P>0.05)。观察组VAS评分术后2 w、6 w低于对照组差异有统计学意义(P<0.05),术后12 w、24 w差异无统计学意义(P>0.05)。术后第1个月、第3个月,观察组前臂旋前角度大于对照组,差异有统计学意义(P<0.05);旋后、掌屈、背伸、桡偏、尺偏差异无统计学意义(P>0.05)。所有患者未出现血管、神经损伤、骨筋膜室综合征、切口感染、骨不连情况并发症。结论:微创掌侧入路保留旋前方肌与切开旋前方肌钢板治疗桡骨远端骨折,都能获得很好的骨折临床愈合及较好的腕关节功能,但在切口及损伤、前臂旋前功能方面,保留旋前方肌的更有优势,而且保留旋前方肌的早期疼痛程度更低,骨折临床愈合更快,值得在临床上推广应用。

Objective To compare the efficacy of minimally invasive volar approach with reserved anterior rotator muscle and open anterior rotator using locking plate in the treatment of distal radius fractures.Method 60 Patients with distal radius fractures were randomly divided into observation group(n=30)and control group(n=30).The observation group was treated with minimally invasive incision retaining anterior rotator muscle reduction and locking plate internal fixation.The control group was treated with open rotator anterior muscle reduction and locking plate internal fixation.The length of incision,operative time,intraoperative blood loss and clinical healing time of fracture were compared between the two groups;standard anteroposterior and lateral radiographs preoperatively and postoperatively,radial inclination,ulnar deviation angle and radius shortening degree of the two groups;VAS scores of the two groups at 2,6,12 and 24 weeks after surgery;The degree of forearm rotation and wrist joint function activity in the first and third month after operation in the two groups;The incidence of postoperative complications in the two groups:compartment syndrome,vascular and nerve injury,infection.Results There were no significant differences in age,sex and limb distribution between the two groups(P>0.05).There was no significant difference in fracture type distribution between the two groups(P>0.05).Incision length in observation group was significantly smaller than that in control group,and the difference was statistically significant(P<0.05).The operation time of the observation group was longer than that of the control group,and the difference was statistically significant(P<0.05),but they were all within a tourniquet duration.The intraoperative blood loss in the observation group was less than that in the control group,and the difference was statistically significant(P<0.05).The clinical healing time of the observation group was shorter than that of the control group,and the difference was statistically significant(P<0.05).Uniform anteroposterior and lateral radiographs:there were no significant differences in radial inclination,ulnar deviation Angle and radius shortening between the two groups before and after operation(P>0.05).VAS score of the observation group was lower than that of the control group at 2 and 6 weeks after surgery,and the difference was statistically significant(P<0.05),but there was no significant difference at 12 and 24 weeks after surgery(P>0.05).At 1 and 3 months after operation,forearm pronation angle in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).There were no significant differences in supination,metacarpal flexion,dorsiflexion,radial deviation and ulnar deviation(P>0.05).None of the patients had vascular or nerve injury,compartment syndrome,incision infection,and bone nonunion.Conclusion Minimally invasive volar approach with reserved anterior rotator muscle and open anterior rotator using locking plate in the treatment of distal radius fractures,can get very good clinical healing of fracture and better wrist function,but in the incision and injury,forearm pronation,keep spinning in front of the muscle is more advantage,and keep turning early pain degree is lower and muscle in front of the bone fracture clinical healing faster,It is worthy of clinical application.