摘要
目的探讨改良 Henry 入路掌侧解剖锁定钢板内固定治疗不稳定桡骨远端骨折的临床疗效。方法选取 2019 年 5 月至 2020 年 5 月我院收治的不稳定桡骨远端骨折患者 45 例,按照入院日期单双号分为改良 Henry 入路组 (23 例) 和传统 Henry 入路组 (22 例)。改良 Henry 入路组 23 例,其中男 12 例,女 11 例;年龄 33~74 岁,平均 (45.75±20.53) 岁;受伤部位右侧 13 例,左侧 10 例;受伤原因跌倒 15 例,车祸8 例;按 AO 分型,B1 型 5 例,B2 型 6 例,B3 型 2 例,C1 型 6 例,C2 型 4 例;受伤致手术时间 4~7 天,平均为 (5.39±0.72) 天。传统 Henry 入路组 22 例,其中男 9 例,女 13 例;年龄 31~75 岁,平均 (50.05±20.18) 岁;受伤部位右侧 12 例,左侧 10 例;受伤原因跌倒 13 例,车祸 9 例;按 AO 分型,B1 型 4 例,B2 型 4 例,C1 型 8 例,C2 型 5 例;受伤致手术时间 4~6 天,平均 (5.00±0.81) 天。分别采用 Dienst 关节评分标准评估患者腕关节功能、影像学指标评估手术疗效,并观察记录两组术中情况及术后并发症发生情况。收集数据后进行统计学处理。结果两组术后均获随访,平均随访时间为 (2.06±0.86) (1~3) 个月,所有患者切口均愈合良好,无感染、坏死。术后 3 个月摄 X 线片显示所有患者骨折愈合良好,无畸形愈合、骨不连,无桡骨高度丢失、关节面塌陷等。两组术中旋前方肌修复率及正中神经刺激、手术时间及术中失血量相比,差异有统计学意义 (P<0.05)。两组术后 3 个月采用 Dienst 关节评分评估患者腕关节功能。改良 Henry 入路组及传统 Henry 入路组腕关节功能评估优良率分别为 96.65%、95.45%,两组相比差异无统计学意义 (P>0.05)。两组术后 3 天、1 个月、3 个月影像学指标 (桡骨高度、掌倾角、尺偏角) 相比,差异无统计学意义 (P>0.05)。改良 Henry 入路组术后屈肌腱激惹、创伤性关节炎、关节僵硬发生率均低于传统 Henry 入路组,两组相比差异无统计学意义 (P>0.05)。结论改良 Henry 入路掌侧解剖锁定钢板内固定治疗不稳定桡骨远端骨折具有术中暴露简单、对旋前方肌损伤小、减少术中出血量、缩短手术时间、减少术后并发症、腕关节功能恢复满意等优势,值得临床应用。
Objective To explore the clinical effect of modified Henry approach palmar anatomical locking plate internal fixation in the treatment of unstable distal radius fractures.Methods Forty-five patients diagnosed as unstable distal radius fractures were selected from May 2019 to May 2020.All were divided into modified Henry approach group (n=23) and traditional Henry approach group (n=22) according to odd or even admission date.Modified Henry approach group:12 males and 11 females;an average age of (45.75±20.53) years (range:33-74 years);13 cases were injured on the right side and 10 cases on the left side;15 cases were injured from falls and8 cases from traffic accidents;5 cases were of type B1,6 cases of type B2,2 cases of type B3,6 cases of type C1,and 4 cases of type C2 according to AO classification;the average time from injury to operation was (5.39±0.72) days(range:4-7 days).Traditional Henry approach group:9 males and 13 females;an average age of (50.05±20.18) years(range:31-75 years);12 cases were injured on the right side and 10 cases on the left side;13 cases were injured from falls and 9 cases from traffic accidents;4 cases were of type B1,4 cases of type B2,8 cases of type C1,and5 cases of type C2 according to AO classification;the average time from injury to operation was (5.00±0.81) days(range:4-6 days).The Dienst joint scoring standard and imaging indicators were used to evaluate wrist functions and surgical efficacy.Intraoperative data and postoperative complications of the 2 groups were recorded.Statistical analysis was performed.Results All patients were followed up for 1-3 months,with an average of (2.06±0.86) months.Good incision healing was observed in all patients without infection or necrosis.X-ray images 3 months after operation showed that all patients had good fracture healing without malunion,nonunion,radial height loss,or articular surface collapse.There were statistically significant differences between the two groups in the repair rate of pronation anterior muscle,median nerve stimulation,operation time,and blood loss during operation (P < 0.05).The Dienst joint scoring standard was used to evaluate wrist functions of the two groups 3 months after operation.The excellent and good rates of wrist functions in the modified Henry approach group and traditional Henry approach group were 96.65%,95.45%,respectively,and the results were not statistically different (P > 0.05).No statistically significant differences in 3 days’,1 month’,and 3 months’ imaging indexes (radius height,palm dip angle,and ulnar angle) were observed between the two groups (P > 0.05).Incidences of flexor tendon irritation,traumatic arthritis,and joint stiffness of the modified Henry approach group were lower than that of the traditional Henry approach group,but the results were not statistically significant (P > 0.05).Conclusions Modified Henry approach palmar anatomical locking plate internal fixation will achieve satisfactory wrist function recovery in the treatment of unstable distal radius fractures with simple intraoperative exposure,shorter operation time,less damage to the anterior pronator muscle,less intraoperative bleeding,and fewer postoperative complications.
作者
李彦宇
赵岩
李孟杰
LI Yan-yu;ZHAO Yan;LI Meng-jie(Orthopedic Center,The First Affiliated Hospital of Xinjiang Medical University,LJrumqi,Xinjiang,830011,China)
出处
《中国骨与关节杂志》
CAS
2020年第9期654-660,共7页
Chinese Journal of Bone and Joint
关键词
桡骨骨折
骨折固定术
内
治疗结果
Radius fractures
Fracture fixation
internal
Treatment outcome
