腕关节镜下保留旋前方肌1 cm小切口微创入路治疗桡骨远端关节内骨折的可行性及疗效观察

Feasibility and efficacy observation of minimally invasive approach for the treatment of intra-articular fractures of the distal radius with 1 cm small incision with preservation of pronator quadratus under wrist arthroscopy

目的探讨腕关节镜下保留旋前方肌1 cm小切口微创入路治疗桡骨远端关节内骨折的可行性及临床疗效。方法我科自2021年9月至2023年2月收治63例桡骨远端关节内骨折患者,采用保留旋前方肌1 cm小切口微创入路手术28例,术中使用腕关节镜辅助;采用传统Henry入路手术35例。比较两组患者的围手术期指标及随访资料。结果63例患者均顺利进行手术。两组患者的一般资料、住院时间、切口愈合等级差异均无统计学意义(P>0.05)。微创组的手术时间(90.0±7.2)min,较传统组(55.0±5.7)min有所增长(P<0.05)。术后随访6~13个月,平均8.3个月。两组患者术后均未发现伤口感染、血管及神经损伤等并发症。随时间推移,所有纳入患者的VAS评分、腕关节各向活动度均逐步得到改善。术后3 d、1周时微创组VAS评分显著低于传统组[(3.8±2.2)vs(6.6±2.3),P=0.026;(3.2±1.4)vs(5.7±2.8),P=0.041];术后1、3、6个月时两组差异均无显著变化(P>0.05)。术后1周时微创组屈伸、旋转活动度明显优于传统组[(90.0±13.8)°vs(81.0±7.6)°,P=0.017;(79.6±9.2)°vs(61.1±15.6)°,P<0.001];术后3个月时Mayo腕关节功能评分,微创组优良率为25/3(89.2%),传统组为29/6(82.85%),差异具有统计学意义(P=0.039)。结论保留旋前方肌1 cm小切口微创入路治疗桡骨远端关节内骨折具有良好的可操作性与可靠性,同时具备创伤小、恢复快、疼痛期短等优点,且改善了术后的关节功能,值得临床推广应用。

Objective To observe the feasibility and clinical efficacy of minimally invasive approach for the treatment of intra-articular fractures of the distal radius with 1 cm small incision with preservation of pronator quadratus under wrist arthroscopy.Methods From September 2021 to February 2023,63 patients with intra-articular fractures of the distal radiuswere treated in our department.28 patients underwent minimally invasive surgery using a 1cm small incision preserving pronator quadratus,with the assistance of wrist arthroscopy during the surgery.35 cases underwent traditional Henry approach surgery.The perioperative indicators and follow-up data between two groups of patients were compared.Results All 63 patients underwent surgery smoothly.There was no statistically significant difference in general information,length of hospital stay,and wound healing level between the two groups of patients(P>0.05).The surgical time in the minimally invasive group was(90.0±7.2)minutes,which was an increase compared to the traditional group(55.0±5.7)minutes(P<0.05).The postoperative follow-up was 6 to 13 months,with an average of 8.3 months.No postoperative complications such as wound infection,vascular or nerve damage were found in both groups of patients.Over time,the VAS and wrist joint range of motion of all included patients gradually improved.At 3 days and 1 week after surgery,the VAS in the minimally invasive group was significantly lower than that in the traditional group[(3.8±2.2)vs(6.6±2.3),P=0.026;(3.2±1.4)vs(5.7±2.8),P=0.041].There was no significant difference between the two groups at 1,3,and 6 months after surgery(P>0.05).At one week after surgery,the minimally invasive group had significantly better flexion,extension,and rotational mobility than the traditional group[(90.0±13.8)°vs(81.0±7.6)°,P=0.017;(79.6±9.2)°vs(61.1±15.6)°,P<0.001].At 3 months after surgery,the Mayo wrist joint function score showed a statistically significant improvement rate of 25/3(89.2%)in the minimally invasive group and 29/6(82.85%)in the traditional group.The difference was statistically significant(P=0.039).Conclusion The minimally invasive approach with 1 cm small incision with preservation of pronator quadratus for the treatment of intra-articular fractures of the distal radius has good operability and reliability,as well as advantages such as minimal trauma,quick recovery,short pain period,and improved postoperative joint function.It is worthy of clinical promotion and application.