保留旋前方肌钢板固定长段粉碎性盖氏骨折

Volar plate fixation of long segment comminuted Galeazzi's fracture without severing pronator quadratus

[目的]介绍保留旋前方肌钢板内固定治疗长段粉碎性Ⅱ型盖氏骨折的的手术技术和初步临床结果。[方法]2018年12月—2022年2月采用保留旋前方肌钢板固定治疗长段粉碎性Ⅱ型盖氏骨折患者14例,采用桡侧腕屈肌与桡动脉间微创切口入路,自腕横纹水平向近端纵向切开约3.0cm,先在远端桡侧切口腕屈肌桡侧分离,将桡侧腕屈肌牵向尺侧,桡动脉牵向桡侧,显露旋前方肌,用骨膜剥离器在旋前方肌下方贴骨膜剥离,建立“肌-骨隧道”后经皮插入合适规格的锁定钢板,复位骨折,三点定位钢板位置,分别拧入螺钉,固定骨折。[结果]所有患者均顺利完成手术,手术时间平均(75.1±15.0)min,术中出血量平均(38.2±30.3)ml,。患者均获随访,随访时间平均(24.6±10.9)个月。术后6个月Mayo评分:疼痛评分(23.6±2.3)分,满意度评分(23.9±2.1)分,活动范围评分(17.1±4.1)分,握力评分(23.6±3.5)分,所有患者均骨性愈合。[结论]保留旋前方肌钢板内固定治疗长段粉碎性Ⅱ型盖氏骨折具有创伤小、内固定确切、患肢功能恢复迅速等优点。

[Objective]To introduce the surgical technique and preliminary clinical results of volar plate fixation of long segment comminuted Galeazzi's fractures without severing pronator quadratus.[Methods]From December 2018 to February 2022,14 patients with long segment comminent typeⅡ Galeazzi's fracture were treated with abovesaid minimally invasive surgery.As an incision between the flexor carpi radialis and the radial artery was made 3.0 cm proximal to the transverse carpal line,the flexor carpi radialis was freed and retracted to the ulnar side,while the radial artery was retracted to the radialis side to reveal the pronator muscle.A periosteal stripper was attached beneath the pronator quadratus to peel off the muscle for establishing a"musculoskeletal tunnel".A volarr locking plate in appropriate size was percutaneously inserted by three-point location.As fractures reduced properly,screws were placed respectively to fix the fractures.[Results]All patients successfully completed the operation with the average operation time of(75.1±15.0)min,and the average intraopera⁃tive blood loss of(38.2±30.3)ml.All of them were followed up for an average of(24.6±10.9)months,and the Mayo score was recorded 6 months after surgery as pain score of(23.6±2.3),satisfaction score of(23.9±2.1),range of motion score of(17.1±4.1),grip strength score of(23.6±3.5),and bone healing achieved in all patients.[Conclusion]The palmar plate fixation of long segment comminuted Galeazzi's frac⁃tures without severing pronator quadratus has advantages of less trauma,accurate internal fixation and rapid functional recovery of affected limb.