保留旋前方肌不同掌侧入路治疗桡骨远端骨折的效果对比

Comparison of the effect of different palmar approaches with preservation of the pronator quadratus in the treatment of distal radius fractures

目的 对比保留旋前方肌不同掌侧入路治疗桡骨远端骨折的效果。方法 28例桡骨远端骨折患者,按照治疗方式差异分为观察组与对照组,各14例。观察组采用保留旋前方肌经皮微创钢板接骨术(MIPPO)入路切开复位固定术治疗,对照组采用保留旋前方肌Henry入路切开复位固定术治疗。比较两组患者临床疗效及术后不同时间点的疼痛程度、腕关节活动程度。结果 观察组患者的治疗优良率85.71%(12/14)高于对照组的50.00%(7/14),差异具有统计学意义(P<0.05)。两组患者术后2、6、12、24周的视觉模拟评分法(VAS)评分均逐渐降低,屈曲活动度、背伸活动度、尺偏活动度均逐渐升高,组内比较差异具有统计学意义(P<0.05)。观察组患者术后2、6、12、24周的VAS评分分别为(2.03±0.32)、(1.23±0.21)、(0.41±0.12)、(0.30±0.10)分,均低于对照组的(4.14±1.23)、(3.36±1.10)、(2.14±0.32)、(1.62±0.23)分;屈曲活动度分别为(33.53±1.42)、(50.14±1.14)、(70.32±1.41)、(89.25±1.46)°,均高于对照组的(22.14±1.26)、(39.14±1.35)、(59.65±1.54)、(74.65±1.62)°;背伸活动度分别为(33.25±5.42)、(45.62±1.25)、(55.14±0.62)、(64.86±1.62)°,均高于对照组的(21.63±1.56)、(34.86±1.62)、(44.86±1.63)、(50.32±1.42)°;尺偏活动度分别为(23.25±3.14)、(29.42±3.14)、(33.62±2.76)、(38.22±3.17)°,均高于对照组的(10.62±1.86)、(17.82±1.75)、(23.45±1.56)、(30.56±5.43)°,差异均具有统计学意义(P<0.05)。结论 保留旋前方肌MIPPO入路较Henry入路切开复位固定术治疗桡骨远端骨折的效果好。

Objective To compare the effect of different palmar approaches with preservation of the pronator quadratus in the treatment of distal radius fractures. Methods A total of 28 patients with distal radius fractures were divided into observation group and control group according to the difference of treatment modality,with 14 patients in each group. The observation group was treated by open reduction and fixation via minimally invasive percutaneous plate osteosynthesis(MIPPO) approach with preservation of the pronator quadratus, and the control group was treated by open reduction and fixation via Henry approach with preservation of the pronator quadratus. The clinical efficacy, pain level and range of motion of wrist joint at different time points after surgery were compared between the two groups. Results The excellent treatment rate of patients in the observation group was 85.71%(12/14), which was higher than 50.00%(7/14) in the control group, and the difference was statistically significant(P<0.05). The visual analogue scale(VAS) scores of patients in both groups gradually decreased at 2, 6, 12, and 24 weeks after surgery, and the flexion mobility, dorsiflexion mobility, and ulnar deviation mobility gradually increased, and the differences within the group was statistically significant(P<0.05). At 2, 6, 12 and 24 weeks after surgery, the VAS scores of patients in the observation group were(2.03±0.32),(1.23±0.21),(0.41±0.12) and(0.30±0.10) points, which were lower than(4.14±1.23),(3.36±1.10),(2.14±0.32) and(1.62±0.23) points in the control group;the flexion mobility of the patients in the observation group were(33.53±1.42),(50.14±1.14),(70.32±1.41) and(89.25±1.46)°, which were higher than(22.14±1.26),(39.14±1.35),(59.65±1.54) and(74.65±1.62)° in the control group;the dorsiflexion mobility of patients in the observation group were(33.25±5.42),(45.62±1.25),(55.14±0.62) and(64.86±1.62)°, which were higher than(21.63±1.56),(34.86±1.62),(44.86±1.63) and(50.32±1.42)° in the control group;the ulnar deviation mobility of patients in the observation group were(23.25±3.14),(29.42±3.14),(33.62±2.76), and(38.22±3.17)°,which were higher than(10.62±1.86),(17.82±1.75),(23.45±1.56), and(30.56±5.43)° in the control group;the differences were all statistically significant(P<0.05). Conclusion Preservation of the pronator quadratus by MIPPO approach is more effective than the Henry approach incision and fixation for distal radius fractures.