两种保留旋前方肌的内固定方法治疗桡骨远端不稳定骨折的近期临床疗效
摘要
目的比较常规旋前方肌下骨膜外置钢板和劈开肱桡肌止点旋前方肌下置钢板内固定治疗桡骨远端不稳定型骨折的近期临床疗效。方法选择2015年11月至2017年2月该院创伤中心收治的60例桡骨远端不稳定骨折的患者,采用Henry入路旋前方肌下骨膜外置插钢板(对照组)和劈开肱桡肌止点旋前方肌下置钢板(观察组)两种手术方式进行治疗,每组30例。观察比较两组手术时间、术中出血量、骨折愈合时间,术前及术后视觉模拟评分法(VAS),术前、术后6个月患侧腕关节功能、术后疗效、并发症及患侧和健侧的B超下纵向和横向长度。结果两组所有患者均得到随访,无1例失访,无1例感染。两组手术时间、术中出血量、骨折愈合时间比较差异均有统计学意义(P<0.05)。观察组患者的VAS评分、Gartland-Werley评分明显优于对照组,差异有统计学意义(P<0.05)。两组治疗后掌屈、背伸、桡偏、尺偏、旋前和旋后功能均较治疗前明显提高(P<0.05),且观察组的桡偏、尺偏、旋前和旋后功能明显优于对照组(P<0.05)。结论劈开肱桡肌止点旋前方肌下置钢板内固定治疗方法可更大范围保留旋前方肌,更加充分暴露骨折端,便于锁定钢板放置,术后腕关节的功能恢复更好。
引文
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[19]孔倩倩,田军,孙博.旋前方肌的影像解剖学研究及其临床意义[J].医学影像学杂志,2013,23(3):450-453.
[20]SATO J,ISHII Y,NOGUCHI H,et al.Sonographic swelling of pronator quadrates muscle in patients with occult bone injury[J].BMC Med Imaging,2015(15):9.
[2]殷斌,刘磊,陈伟,等.2003-2012年河北医科大学第三医院成人尺桡骨远端骨折的流行病学研究[J].中华创伤骨科杂志,2014,16(4):316-319.
[3]ROZENTAL T D,BLAZAR P E,FRANKO O I,et al.Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation.A prospective randomized trial[J].J Bone Joint Surg Am,2009,91(8):1837-1846.
[4]刘杰,李少华,楼列名,等.掌侧锁定钢板治疗不稳定型桡骨远端骨折疗效及并发症分析[J].实用医学杂志,2010,26(5):796-798.
[5]刘兆杰,张银光,胡永成.锁定加压钢板治疗不稳定型桡骨远端骨折[J].中华创伤杂志,2011,27(8):698-702.
[6]卢荟,童培建.桡骨远端骨折治疗概述与进展[J].浙江临床医学,2011,13(4):446-450.
[7]AHSAN Z S,YAO J.The importance of pronator quadrates repair in the treatment of distal radius fractures with volar plating[J].Hand,2012,7(3):276-280.
[8]TOSTI R,ILYAS A M.Ilyas AM prospective evaluation of pronator quadratus repair following volar plate fixation of distal radius fractures[J].J Hand Surg,2013,38(9):1678-1684.
[9]石展英,赵良军,李百川,等.单侧多功能组合架与锁定加压钢板治疗C型桡骨远端骨折的疗效分析[J].中华手外科杂志,2013,29(1):13-14.
[10]ATESCHRANG A,STUBY F,WERDIN F,et al.Flexor tendon irritations after locked plate fixation of the distal radius with the 3.5mm T-Plate:identification of risk factors[J].Z Orthop Unfall,2010,148(3):319-325.
[11]SWIGART C R,BADON M A,BRUEGEL V L,et al.Assessmrent of pronator quadratus repair integrity following volar platefixation for distal radius fractures:a prospective clinical cohort study[J].J Hand Surg Am,2012,37(9):1868-8173.
[12]FIGL M,WENINGER P,LISK M,et al.Volar fixed-angle plate osteosynthesis of unstable distal radius fractures:12months results[J].Aech Orthop Trauma Surg,2009,129(5):661-669.
[13]李当科,吕夫新,孙正考,等.探讨旋前方肌缝合与否对腕关节功能无明显影像的原因[J].中华创伤骨科杂志,2015,17(6):536-538.
[14]罗卫华,叶峥,朱剑.桡掌侧入路锁定钢板治疗桡骨远端粉碎性骨折[J].临床骨科杂志,2014,17(1):56-58.
[15]HERSHMAN S H,IMMERMAN I,BECHTEL C,et al.The effect of pronator quadrates repire on outcome after volar plating of distal radius fractures[J].J Orthop Trauma,2013,27(3):130-133.
[16]MULDERS M A M,WALENKAMP M M J,BOS F J ME,et al,Repair of the pronator quadratus after volar plate fixation in distal radius fractures:a systematic review[J]Strategies Trauma Limb Reconstr,2017,12(3):181-188.
[17]NHO J H,GONG H S,SONG C H,et al.Examination of th pronator quadratus muscle during hardware removal procrdures after volar plating for distal radius fractures[J].Clini Orthop Surg,2014,6(3):267-272.
[18]LO H Y,CHENG H Y.Clinical study of the pronator quadratus muscle:anatomical features and feasibility of pronator-sparing surgery[J].BMC Musculoskelet Disord,2014(15):136.
[19]孔倩倩,田军,孙博.旋前方肌的影像解剖学研究及其临床意义[J].医学影像学杂志,2013,23(3):450-453.
[20]SATO J,ISHII Y,NOGUCHI H,et al.Sonographic swelling of pronator quadrates muscle in patients with occult bone injury[J].BMC Med Imaging,2015(15):9.