摘要
目的比较经掌背侧联合入路内固定术与掌侧入路万向锁定加压钢板内固定术治疗桡骨远端骨折的疗效。方法收集2015年3月—2018年10月在上海交通大学附属第一人民医院和上海交通大学附属第六人民医院行手术治疗的75例AO C3型桡骨远端骨折患者,根据手术方式将患者分为单纯掌侧入路万向锁定加压钢板内固定术组(单侧入路组,40例)和经掌背侧联合入路内固定术组(联合入路组,35例)。比较两组患者的一般资料(性别、年龄、致伤原因、手术切口长度、手术时间),术后随访通过X线摄片观察骨折复位、关节面平整性、内固定位置和骨折愈合情况,术后12个月的上肢功能评分(disabilities of the arm,shoulder and hand,DASH评分)和Mayo腕关节功能评分,以及术后并发症情况。结果联合入路组的手术切口长度和手术时间均显著长于单侧入路组(P值均<0.01)。两组术后桡骨复位和愈合均良好,关节面平整,内固定物无移位,腕关节无骨关节炎改变。联合入路组掌倾角、尺偏角分别为(12.1±2.1)°、(22.3±2.2)°,分别大于单侧入路组的(10.2±2.0)°、(20.7±2.1)°,差异均有统计学意义(P值均<0.05)。联合入路组、单侧入路组的桡骨高度分别为(12.0±1.2)、(11.4±2.3)mm,两组间的差异无统计学意义(P>0.05)。术后12个月,联合入路组DASH评分、Mayo腕关节功能评分分别为12.4(2.2,22.4)、88.0(80.0,100.0)分,单侧入路组分别为15.4(4.5,30.4)、83.4(75.0,95.0)分;两组间DASH评分和Mayo腕关节功能评分的差异均无统计学意义(P值均>0.05)。两组患者术后愈合均良好,均无肌腱断裂、软组织感染和坏死、复杂性区域疼痛综合征、血管神经并发症等发生。联合入路组中有1例患者发生伸肌腱激惹。结论经掌背侧联合入路内固定和掌侧入路万向锁定加压钢板内固定治疗AO C3型桡骨远端骨折均有效,患者腕关节功能均得以恢复。
Objective To compare the efficacy of combined volar and dorsal plate and variable-angle locking compression plate in the treatment of distal radius fractures.Methods A total of 75 patients with distal radius fractures(AO type C3)admitted to Shanghai First People’s Hospital and Shanghai Sixth People’s Hospital from March 2015 to October 2018 were enrolled in this study.They were divided into a volar approach group(40 cases)and a combined approach group(35 cases).The general information,such as sex,age,cause of injury,length of incision,and operation time were compared between the two groups.The reduction of fracture,flatness of articular surface,location of internal fixation,fracture healing,postoperative 12-month DASH(disabilities of the arm,shoulder and hand)score,Mayo wrist functional score,and complications were evaluated during follow up.Results Both length of incision and operation time in the combined approach group were significantly longer than those in the volar approach group(both P<0.01).The reduction and healing of the radius were good in both groups,the articular surface was smooth,the internal fixation did not shift,and the wrist joint did not have osteoarthritis.The palmar tilt and ulnar deviation in the combined approach group were significantly larger than those in the volar approach group(12.1°±2.1°vs.10.2°±2.0°,22.3°±2.2°vs.20.7°±2.1°,both P<0.05).The radial height was(12.0±1.2)mm in the combined approach group and(11.4±2.3)mm in the volar approach group(P>0.05).Twelve months after operation,the DASH score was 12.4(2.2,22.4)and Mayo wrist functional score was 88.0(80.0,100.0)in the combined approach group;these two scores were 15.4(4.5,30.4)and 83.4(75.0,95.0)in the volar approach group(both P>0.05).The fracture healed well,and no tendon rupture,soft tissue infection,necrosis,complicated regional pain syndrome or vascular/nerve complications occurred.Extensor tendon irritation was found in one patient of the combined approach group.Conclusion The internal fixation with the com
作者
魏小康
王传舜
李豪青
WEI Xiaokang;WANG Chuanshun;LI Haoqing(Department of Orthopaedics,Shanghai Sixth People’s Hospital,Shanghai 200233,China;不详)
出处
《上海医学》
CAS
2021年第5期343-347,共5页
Shanghai Medical Journal
关键词
桡骨远端骨折
掌背侧联合入路
万向锁定加压钢板
Distal radius fracture
Combined volar and dorsal approaches
Variable-angle locking compression plate
