目的 探讨掌侧入路及背侧入路治疗桡骨远端不稳定型骨折的疗效。方法 选取武警西藏总队医院2016-06至2021-06收治的行切开复位锁定加压钢板内固定术治疗桡骨远端不稳定性骨折患者59例,根据桡骨远端骨折移位趋势不同分为掌侧入路组(31例)和背侧入路组(28例)。比较两组手术后掌倾角、桡骨高度、尺偏角、术后1个月内早期并发症发生率、术后6个月远期并发症发生率及腕关节功能。结果 两组术后掌倾角、桡骨高度及尺偏角、住院天数及愈合时间差异无统计学意义。手术时间掌侧组(85.50±11.21)min短于背侧组(94.75±15.55)min,术中出血量掌侧组(125.54±28.78)ml大于背侧组(110.78±25.71)ml,差异有统计学意义(P＜0.05)。术后1个月近期并发症比较,掌侧组正中神经损伤4例,多于背侧组,但是肌腱损伤率少于背侧组,差异有统计学意义(P＜0.05),两组桡动脉损伤、切口感染、桡神经损伤发生率差异无统计学意义。6个月远期并发症及腕关节功能恢复优良率差异均无统计学意义(P＞0.05)。结论 根据不同移位趋势选择不同入路均能有效治疗桡骨远端不稳定型骨折,恢复腕关节稳定性,获得良好的临床效果。
Abstract
Objective To study the clinical efficacy of the volar approach and the dorsal approach in the treatment of unstable fractures of distal radius. Methods Fifty-nine patients with unstable fractures of distal radius who were treated with open reduction and locking compression plate were selected from Tibet Autonomous Region Corps Hospital of Chinese People’s Armed Police Force from June 2016 to June 2021. According to the displacement trend of distal radius fractures, they were divided into the volar approach group (31 cases) and the dorsal approach group (28 cases). The postoperative palmar angle, radial height, ulnar angle, the incidence of early complications within 1 month after operation, the incidence of long-term complications within 6 months after operation, and the wrist function at 6 months after operation were compared between the two groups. Results There were no statistically significant differences in palmar tilt angle, radius height, ulnar angle, length of hospital stay or healing time between the two groups between the two groups (P＞0.05) . The operative time was shorter in volar approach group (85.50±11.21 min) than in dorsal approach group (94.75±15.55 min), the intraoperative bleeding volume was greater in volar approach group (125.54±28.78 ml) than in the dorsal approach group (110.78±25.71 ml), and the differences were statistically significant (P<0.05). In the comparison of recent complications 1 month after surgery, there were 4 cases of median nerve injury in volar approach group, which was more than that in the dorsal approach group, but the rate of tendon injury was lower than that in the dorsal approach group, and the difference was statistically significant (P<0.05). There was no statistically significant difference in the incidence of radial artery injury, incisional infection, or radial nerve injury between the two groups (P＞0.05). There was no significant difference in the 6-month long-term complication rate or the excellent and good recovery rate of wrist joint function between the two groups (P>0.05). Conclusions Different approaches based on different displacement trends can effectively treat unstable fractures of distal radius and regain stability of the wrist joint, which can obtain positive clinical outcomes.
关键词
桡骨远端不稳定型骨折 /
切开复位内固定术 /
掌侧入路 /
背侧入路
Key words
unstable fracture of distal radius /
open reduction and internal fixation /
volar approach /
dorsal approach
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