Henry入路复位固定桡远端骨折是否缝合旋前方肌

Reduction and fixation of distal radial fracture by Henry approach with or without pronator quadratus reattachment

摘要:

［目的］ 探讨 Henry 入路复位固定桡远端骨折是否缝合旋前方肌对术前早期临床结果的影响。［方法］ 回顾性分析 2018 年 1 月—2019 年 8 月本科采用 Henry 入路复位固定 AO-C 型桡远端骨折的 52 例患者的临床资料。依据术前医患沟通结果，20 例完成复位内固定后术中缝合旋前方肌，32 例术中未缝合旋前方肌。比较两组患者围手术期和短期随访资料。［结果］ 两组患者均顺利完成手术，两组手术时间、切口长度、切口愈合等级和住院时间的差异均无统计学意义 （P>0.05）。两组患者均获随访 3 个月以上，随着时间推移，两组 VAS 疼痛评分、腕关节掌屈-背伸 ROM、腕关节桡偏-尺偏 ROM 及前臂旋前-旋后 ROM 均显著改善 （P<0.05）。术后 1 周和 1 个月时缝合组 VAS 评分显著低于未缝合组 [(3.3±0.5) vs (5.3±1.3) , P<0.001; (2.5±0.8) vs (3.2±1.0) , P=0.008]；术后 1 个月时缝合组患者前臂旋前-旋后 ROM 显著大于未缝合组 [(90.3±15.9)° vs (79.6±9.5)°, P=0.011]。 术后 3 个月时按 Gartland-Werley 标准，缝合组腕关节功能优良率为 18/2 （90.0%），未缝合组为 24/4 （78.0%），差异无统计学意义（P>0.05）。［结论］Henry 入路开放复位内固定桡远端骨折缝合旋前方肌可有效缓解术后短期疼痛，并可改善术后前臂旋转活动度。

Abstract:

[Objective] To investigate the effect of pronator quadratus reattachment on the early clinical outcome of open reduction and internal fixation (ORIF) of distal radial fracture by Henry approach. [Methods] A retrospective study was conducted on 52 patients who re- ceived ORIF for AO type C distal radial fractures by Henry approach in our department from January 2018 to August 2019. According to the preoperative doctor-patient communication, 20 patients had the pronator quadratus reattached with suture (RA) following ORIF, while the other 32 patients remained the muscle in non-reattachment (NR) by suture. The perioperative and short-term follow-up data of the two groups were compared. [Results] All patients in both groups had the corresponding operations performed successfully, with no significant differences in terms of operation time, incision length, incision healing grade and hospital stay between the two groups (P＞0.05) . With time of the followed- up period lasted for more than 3 months after surgery, the VAS score for pain wrist flexion- extension range of motion (ROM) , radio- ulnar deviation ROM and forearm pronation- supination ROM significantly improved in both groups (P＜0.05) . The RA group proved significantly superior to the NR group in terms of VAS score at 1 week and 1 month postoperatively [(3.3±0.5) vs (5.3±1.3) , P＜ 0.001; (2.5±0.8) vs (3.2±1.0) , P=0.008] , as well as the forearm pronation-supination ROM 1 month after surgery [(90.3±15.9)° vs (79.6± 9.5)° , P=0.011] . According to Gartland-Werley criteria 3 months after surgery, the excellent and good rate of joint function was 18/2 (90.0%) in the RA group, while 24/4 (78.0%) in NR group, which was not statistically significant (P＞0.05) . [Conclusion] The pronator qua- dratus reattachment in open reduction internal fixation by Henry approach for distal radial fractures does effectively relieve postoperative pain and improve postoperative forearm rotational motion.