腕关节镜辅助复位手术与传统切开复位内固定术对桡骨远端关节面塌陷骨折功能改善的前瞻性随机对照观察

Prospective randomized controlled observation study of wrist arthroscopy assisted reduction surgery versustraditional open reduction and internal fixation surgery for distal radius articular surface collapse fracture

目的比较腕关节镜辅助复位手术与传统切开复位内固定术治疗桡骨远端关节面塌陷骨折的关节面复位情况及不同时期功能恢复情况。方法选取2022年11月至2023年12月深圳市第二人民医院足踝外科手外科收治的桡骨远端关节面塌陷患者34例,以简单随机法分为腕关节镜辅助复位组与传统切开复位组,每组17例。对腕关节镜辅助复位组行关节镜辅助切开复位内固定术,对传统切开复位组行传统切开复位内固定术。对两组患者的关节面复位情况,手术时长,术后2周、6周、12周腕关节旋转屈伸、尺桡偏活动范围、握力及腕关节患者自行评估量表(PRWE)评分进行统计,对手术并发症情况进行对比。采用SPSS 26.0软件对数据进行统计学分析;P<0.05为差异有统计学意义。结果与传统切开复位组相比,腕关节镜辅助复位组的手术时长较长,术后冠状位及矢状位相邻骨块最大位移较小,术后12周腕关节旋转活动范围患侧占健侧百分比显著提高,差异均有统计学意义(P<0.05)。腕关节镜辅助组术后2周、6周腕关节旋转活动范围,握力及腕关节PRWE,术后各时间节点腕关节屈伸、尺桡偏活动范围与传统切开复位组相比差异均无统计学意义(P>0.05)。结论关节镜辅助手术对于桡骨远端关节面塌陷骨折的复位情况较传统切开复位手术效果更好,且关节镜辅助复位桡骨远端骨折对于改善患者术后12周的腕关节旋转活动范围有更好的效果。

Objective To compare the reduction of articular surface and functional recovery in different periods between wrist arthroscopy assisted reduction and traditional open reduction and internal fixation for articular surface collapse fracture of distal radius.Methods From November 2022 to December 2023,34 patients with articular surface collapse of the distal radius fracture were admitted from the Department of Hand and Foot and Ankle Surgery,Shenzhen Second People's Hospital.They were divided into the wrist arthroscopy assisted reduction group and the traditional open reduction group by simple random method,with 17 cases in each group.Arthroscopic assisted open reduction and internal fixation surgery was performed on the wrist arthroscopy assisted reduction group,and the traditional open reduction and internal fixation surgery was performed on the traditional open reduction group.The reduction of the articular surface,the operation time,the wrist rotation range of motion,flexion and extension,ulnar-radial deviation range of motion,the grip strength and patient-rated wrist evaluation(PRWE)subjective rating scale at 2 weeks,6 weeks and 12 weeks after operation,and the surgical complications were compared between the two groups.The SPSS 26.0 software was used for statistical analysis of the data.P<0.05 was considered statistically significant.Results Compared with the traditional open reduction group,the operation time of the wrist arthroscopy assisted reduction group was longer,the maximum displacement of the adjacent bones in the coronal and sagittal positions after operation was smaller,and the percentage of the affected side of the wrist rotation range of motion to the healthy side was significantly increased at 12 weeks after operation,the differences were statistically significant(P<0.05).There were no significant differences in wrist flexion and extension range,ulnar-radial deviation range of motion at each follow up time,wrist rotation range of motion,grip strength and wrist PRWE between the wrist arthroscopic assisted group and the traditional open reduction group at 2 weeks,6 weeks after operation(P>0.05).Conclusion The arthroscopic assisted surgery has a better effect on the reduction of distal radius articular surface collapse fractures than traditional open reduction surgery,and the arthroscopic assisted reduction surgery of distal radius fractures has a better effect on improving the wrist range of rotation activity at 12 weeks after operation.