肱桡肌腱入路保留旋前方肌治疗桡骨远端骨折

The brachioradialis tendon approach to preserve the pronator muscle in the treatment of distal radius fractures

目的探讨肱桡肌腱入路保留旋前方肌改良Henry入路治疗不稳定桡骨远端骨折临床效果。方法回顾性分析2019年12月至2020年11月收治的31例桡骨远端骨折患者,男12例,女19例;年龄22~65岁,平均48.16岁;道路交通伤6例,摔伤22例,高处坠落伤3例;均采用肱桡肌腱入路、保留旋前方肌。记录术中出血量、手术时间,观察骨折愈合、内置物及术后并发症情况。分别采用Dienst评分评价末次腕关节功能、前臂旋转角度观察术后腕关节活动度。结果手术时间35~55 min,平均47.42 min;术中出血量20~35 ml,平均23 ml;随访时间1年以上。骨折块均获得良好愈合,愈合时间11~14周,平均11.75周。术区皮肤愈合良好,无严重神经、血管损伤,术后不同时间段患者腕关节正侧位显示,桡骨高度、掌倾角、尺偏角相比差异均无统计学意义(F=2.86、0.224、5.56,P=0.73、0.80、0.09),未见其角度丢失及骨折再次移位。术后不同时间段疼痛视觉模拟评分(visual analogue scale,VAS)与术前相比较,差异有统计学意义(F=813.86,P<0.01)。术后不同时间段前臂旋前角度和旋后角度差异有统计学意义(F=465.66、288.42,P均<0.01)。末次随访根据Dienst评分评价腕关节功能,其中优13例,良15例,可3例,优良率为90%(28/31)。6例患者在取出内固定装置时发现旋前方肌未出现萎缩。结论行改良Henry入路切开肱桡肌腱后保留旋前方肌治疗桡骨远端骨折,骨折复位满意、出血量少、手术时间短,术后可获得良好腕关节功能且内固定位置未见丢失,是临床上可优先选择的手术方法。

Objective To investigate the clinical effect of the brachioradialis tendon approach in the treatment of unstable distal radius fractures with the modified Henry approach retaining the pronator muscle.Methods A retrospective analysis was performed on 31 patients with distal radius fracture admitted from December 2019 to November 2020,including 12 males and 19 females.The mean age was 48.16 years(range:22-65 years).There were road trafflc injuries in 6 cases,falls in 22 cases and fall from height in 3 cases.The brachioradialis tendon approach was used to preserve the pronator muscle.Intraoperative blood loss and operation time were recorded.Fracture healing,implants and postoperative complications were observed.Dienst score was used to evaluate the last wrist joint function and forearm rotation angle to observe postoperative range of motion.Results The operation lasted 35-55 mins,with the average of 47.42 mins.Intraoperative blood loss ranged from 20 to 35 ml,with an average of 23 ml.The follow-up was more than 1 year.The healing time was 11-14 weeks,with the mean of 11.75 weeks.The skin of the operative area healed well without serious nerve and vascular injury.Anteroposterior and lateral views of the wrist at different time points after surgery showed no statistically significant differences in radius height,palmar angle and ulnar deviation(F=2.86,0.224,5.56,P=0.73,0.80,0.09).Neither loss of angle nor re-collapse was observed.VAS scores at different time periods after surgery were signiflcantly different from those before surgery(F=813.86,P 0.01).There were signiflcant differences in pronation angle and supination angle of the forearm at different time points after surgery(F=465.66,288.42,P< 0.01).At the last follow-up,Dienst score was used to evaluate the wrist function.Among them,13 cases were excellent,15 cases were good,and 3 cases were fair.The excellent and good rate was 90%(28/31).Conclusions The modifled Henry approach incision of the brachioradialis tendon and the retention of the rotator anterior muscle in the treatment of distal radius fracture is preferred in clinical treatment,with satisfactory fracture reduction,less blood loss,short operation time,good wrist function and internal flxation position.