两种入路开放复位内固定桡骨远端骨折的比较

Comparison of two approaches for open reduction and internal fixation of distal radius fractures

摘要:

[目的] 探讨桡侧腕屈肌腱 （flexor carpi radialis tendon, FCRT） 入路与桡骨远端 Henry 入路内固定治疗 C3 型桡骨远端骨折的疗效。[方法]回顾性分析本院 2018 年 1 月—2023 年 1 月收治的 100 例 C3 型桡骨远端骨折患者的临床资料。依据不同时间段，后期的 54 例患者采用 FCRT 入路，早期的 46 例患者采用传统的 Henry 入路。对比两组围手术期、随访及影像指标。 [结果]两组患者均成功完成手术。FCRT 组骨折显露时间 [(10.5±1.0) min vs (13.6±1.2) min, P＜0.001]、手术时间 [(56.4±5.3) min vs (60.0±6.4) min, P=0.003]、术中失血量 [(20.0±3.6) mL vs (23.5±4.0) mL, P＜0.001] 均显著优于 Henry 组。随访时间平均（24.0±3.0） 个月，FCRT 组恢复完全负重活动时间 [(80.5±7.5) d vs (84.0±8.6) d, P=0.032] 显著早于 Henry 组，与术后 1 个月相比，末次随访时，两组 VAS 评分、DASH 评分、G-W 评分、腕伸-屈 ROM、尺偏-桡偏 ROM、旋前-旋后 ROM 均显著改善（P＜0.05），术后 1 个月，FCRT 组 VAS 评分 [(2.3±0.4) vs (2.8±0.6), P＜0.001]、DASH 评分 [(14.0±3.2) vs (15.7±4.2), P=0.024]、G-W 评分 [(8.0±1.8) vs (9.1±2.0), P=0.005] 均显著优于 Henry 组。影像方面，两组关节面复位情况比较差异无统计学意义（P＞0.05）。与术前相比，末次随访，两组掌倾角（palmar tilt, PT）、尺偏角（radial inclination, RI）、桡骨高度（radial length, RL）均显著增加（P＜0.05），相应时间点，两组上述影像指标的差异均无统计学意义（P＞0.05）。[结论]与传统 Henry 入路相比，桡侧腕屈肌腱（flexor carpi radialis tendon, FCRT）入路开放复位内固定 C3 型桡骨远端骨折可显著减少手术创伤，更有利于早期功能恢复。

Abstract:

[Objective] To compare the clinical efficacy of open reduction and internal fixation (ORIF) through flexor carpi radialis tendon (FCRT) approach versus conventional Henry approach for type C3 distal radius fractures. [Methods] A retrospective study was conducted on 100 patients received ORIF for type C3 distal radius fracturesin our hospital from January 2018 to January 2023. According to different time periods, 54 patients in the late stage were treated through the FCRT approach, while 46 patients in the early stage were treated through the traditional Henry approach. The perioperative period, follow-up and imaging documents of the two groups were compared. [Results] All patients in both groups had operation completed successfully. The FCRT group was significantly superior to the Henry group in terms of fracture exposure time [(10.5±1.0) min vs (13.6±1.2) min, P＜0.001], operation time [(56.4±5.3) min vs (60.0±6.4) min, P=0.003], intraoperative blood loss [(20.0±3.6) mL vs (23.5±4.0) mL, P＜0.001]. The average follow-up time was of (24.0±3.0) months, and the FCRT group resumed full weight- bearing activity significantly earlier than the Henry group [(80.5±7.5) d vs (84.0±8.6) d, P=0.032]. The VAS score, DASH score, G-W score, wrist extension-flexion ROM, ulnar- radial ROM and pronation- supination ROM were significantly improved in both groups at the last follow-up compared with those 1 month after surgery (P＜0.05). FCRT group was significantly better than the Henry group in terms of VAS score [(2.3±0.4) vs (2.8±0.6), P＜0.001], the DASH score [(14.0±3.2) vs (15.7±4.2), P=0.024], the G-W score [(8.0±1.8) vs (9.1±2.0), P=0.005] one month postoperatively. As for imaging, there was no a significant difference in articular surface reduction between the two groups (P＞0.05). The palmar tilt (PT), radial inclination (RI) and radial length (RL) in both groups were significantly increased at the latest follow-up compared with those preoperatively (P＜0.05), whereas which were not statistically significant between the two groups at any matching time points(P＞0.05). [Conclusion] The open reduction and internal fixation through the flexor carpi radialis tendon (FCRT) approach for type C3 distal radius fractures does significantly reduce surgical trauma, and is more conducive to early functional re-covery over the traditional Henry approach.