保留旋前方肌小切口掌侧解剖锁定钢板辅助复位内固定治疗不稳定桡骨远端骨折疗效分析

Efficacy analysis of preserving pronator quadratus and small incision with volar anatomical plate assisted reduction and internal fixation for unstable distal radius fractures

目的 研究保留旋前方肌小切口掌侧解剖锁定钢板辅助复位内固定治疗不稳定桡骨远端骨折的可行性并观察术后临床疗效。方法 回顾性分析自2020-04—2022-03诊治的60例不稳定桡骨远端骨折,观察组28例术中采用保留旋前方肌小切口,手法复位联合掌侧解剖锁定钢板辅助复位骨折,对照组32例采用常规Henry切口撬拨复位并克氏针临时固定骨折。比较两组切口长度、手术时间、术中出血量、术后住院时间、骨折愈合时间、腕关节Gartland-Werley评分,术后桡骨远端掌倾角、尺偏角、桡骨茎突高度,以及术后疼痛VAS评分、腕关节活动度。结果 60例均获得随访,随访时间12~20个月,平均15.8个月。所有患者均未发生正中神经损伤、切口愈合不良、切口感染、肌腱断裂、内固定松动或断裂等严重并发症。观察组手术切口长度较对照组短,术中出血量较对照组少,术后住院时间较对照组短,术后第3天、术后1个月疼痛VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组与对照组手术时间、骨折愈合时间、术后3个月疼痛VAS评分、术后6个月腕关节Gartland-Werley评分差异无统计学意义(P>0.05)。两组术后桡骨远端掌倾角、尺偏角、桡骨茎突高度、腕关节(前屈、后伸)活动度、前臂旋后活动度差异无统计学意义(P>0.05)。观察组术后第3天、术后1个月前臂旋前活动度比对照组更大,差异有统计学意义(P<0.05);但是两组术后3个月前臂旋前活动度差异无统计学意义(P>0.05)。结论 采用保留旋前方肌小切口掌侧解剖锁定钢板辅助复位内固定治疗不稳定桡骨远端骨折能获得满意的临床疗效,可以减轻术后疼痛,有利于患者早期功能锻炼及快速康复,更早获得满意的前臂旋前功能。

Objective To investigate the feasibility of preserving pronator quadratus and small incision with volar anatomical plate assisted reduction and internal fixation for unstable distal radius fractures and to observe the postoperative clinical effica⁃cy.Methods A retrospective analysis was performed on 60 cases of unstable distal radius fractures diagnosed and treated from April 2020 to March 2022.In the observation group,28 cases were treated with small incisions preserving pronator quadratus,manual reduction combined with palmar anatomic locking plate to assist fracture reduction,while in the control group,32 cases were treated with conventional Henry incision for reduction and temporary fixation with Kirschner wire.Incision length,opera⁃tion time,intraoperative blood loss,postoperative hospital stay,fracture healing time,wrist Gartland-Werley score,distal radius palmar angle,ulnar declination angle,radius styloid height,postoperative pain VAS score and range of motion(ROM)of wrist were compared between the two groups.Results All 60 cases were followed up for 12 to 20 months,with an average of 15.8 months.No serious complications such as median nerve injury,poor incision healing,incision infection,tendon rupture,loosen⁃ing or rupture of internal fixation occurred in all patients.The surgical incision length,intraoperative blood loss and postopera⁃tive hospital stay in the observation group were better than those in the control group,and the pain VAS score on the 3rd day and 1 month after surgery was lower than that in the control group,with statistical significance(P<0.05).There was no significant dif⁃ference in operation time,fracture healing time,pain VAS score at 3 months after surgery and wrist Gartland-Werley score at 6 months after surgery between observation group and control group(P>0.05).There were no significant differences in distal pal⁃mar inclination angle,ulnar declination angle,styloid height,ROM of wrist(flexion and extension)and ROM of forearm supina⁃tion between the two groups(P>0.05).ROM of forearm pronation in the observation group was higher than that in the control group on the 3rd day and 1 month after surgery,and the difference was statistically significant(P<0.05).However,there was no significant difference in ROM of forearm pronation 3 months after surgery between the two groups(P>0.05).Conclusion Pre⁃serving pronator quadratus and small incision with volar anatomical plate assisted reduction and internal fixation for unstable distal radius fractures can obtain satisfactory clinical effect.This operation can reduce the postoperative pain of patients,facili⁃tate early functional exercise and rapid rehabilitation,and obtain satisfactory forearm pronation function earlier.