保留旋前方肌完整性联合掌侧锁定钢板内固定治疗桡骨远端骨折

Preservation of pronator quadratus muscle combined with volar locking plate in the treatment of distal radial fractures

背景:桡骨远端骨折最常用入路是传统Henry入路,但术中需切断旋前方肌,修复旋前方肌失败会带来一系列并发症。目的:探讨保留旋前方肌联合掌侧锁定钢板治疗桡骨远端骨折的临床效果。方法:回顾性分组对照分析64例桡骨远端骨折患者的临床资料,其中采取保留旋前方肌完整性方法的为改良组32例,按AO分型,23-B1型8例,23-B2型7例,23-B3例7例,23-C1型6例,23-C2型4例;采取传统Henry入路切断旋前方肌方法的为传统组32例,其中23-B1型7例,23-B2型9例,23-B3型3例,23-C1型6例,23-C2型7例。观察两组患者术后内固定、骨折愈合、术后并发症等情况,比较两组术后腕部疼痛目测类比评分(VAS),分别采用Dienst关节评分标准评估患者腕关节功能、影像学指标评估手术疗效。结果与结论:①改良组患者的平均手术时间及术中平均失血量均显著少于传统组(Z=-6.77,P<0.01;Z=-5.41,P<0.01);②改良组患者骨折平均愈合时间短于传统组(Z=-2.08,P<0.05);③术后12个月改良组和传统组患者腕关节功能优良率分别为94%(30/32)、88%(28/32),差异无显著性意义(χ2=0.767,P=0.682);④术后3 d及1,3个月两组患者腕关节正侧位X射线片显示,桡骨高度、掌倾角、尺偏角相比差异均无显著性意义(P>0.05);⑤术后1周及1,3个月改良组患者目测类比评分均低于传统组(P<0.05),而术后12个月两组患者目测类比评分相比差异无显著性意义(P>0.05);⑥两组患者术后均未出现创伤性关节炎;传统组有2例腕管综合(Ⅱ期取出内固定装置症状缓解);⑦结果说明,保留旋前方肌的改良Henry方法在后期旋前角度和疼痛上没有显著优势;然而,术中可以缩短手术时间,减少术中出血,减少术后早期疼痛,促进早期活动。

BACKGROUND:The most commonly used approach for distal radial fractures is the traditional Henry approach,but the pronator quadratus muscle needs to be cut off during operation.Failure to repair the pronator quadratus muscle will bring a series of complications.OBJECTIVE:To investigate the clinical effect of preserving pronator quadratus muscle and volar locking plate in the treatment of distal radial fractures.METHODS:A retrospective case-control study was conducted to analyze the clinical data of 64 patients with distal radial fractures,including 32 patients in the modified group(preserving pronator quadratus muscle).According to AO classification,there were 8 cases of 23-B1 type,7 cases of 23-B2 type,7 cases of 23-B3 type,6 cases of 23-C1 type,and 4 cases of 23-C2 type.In the traditional group(cutting the pronator quadratus muscle via traditional Henry approach),there were 32 cases.According to AO classification,there were 7 cases of 23-B1 type,9 cases of 23-B2 type,3 cases of 23-B3 type,6 cases of 23-C1 type and 7 cases of 23-C2 type.The postoperative internal fixation,fracture healing,postoperative complications and other conditions of the two groups were observed,and the visual analog scale score of wrist pain was compared between the two groups.The wrist function of the patients was evaluated by Dienst joint score standard and the surgical effect was evaluated by imaging indicators.RESULTS AND CONCLUSION:(1)The average operation time and average intraoperative blood loss were significantly less in the modified group than those in the traditional group(Z=-6.77,P<0.01;Z=-5.41,P<0.01).(2)The average healing time in the modified group was shorter than that in the traditional group(Z=-2.08,P<0.05).(3)At 12 months after operation,the excellent and good rates of the wrist function in the modified group and the traditional group were 94%(30/32)and 88%(28/32)respectively,with no significant difference(χ2=0.767,P=0.682).(4)There was no significant difference in radial height,palmar inclination and ulnar deviation between the two groups shown by anteroposterior and lateral X-ray examination of wrist joint at 3 days,1 and 3 months after operation(P>0.05).(5)The visual analog scale score of the modified group was lower than that of the traditional group at 1 week,1 and 3 months after operation(P<0.05),but there was no significant difference in visual analog scale score between the two groups at 12 months after operation(P>0.05).(6)There was no traumatic arthritis in both groups.In the traditional group,there were two cases of carpal tunnel syndrome(II stage removal of internal fixation device).(7)It is concluded that the modified Henry method with the preservation of pronator quadratus muscle has no significant advantages in the late pronation angle and pain.However,intraoperative surgery can shorten the operation time,reduce intraoperative bleeding,reduce early postoperative pain,and promote early activities.