本文關(guān)鍵詞： 橈骨遠(yuǎn)端骨折 掌側(cè)手術(shù)入路 背側(cè)手術(shù)入路 功能評(píng)價(jià)　出處：《廣西中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析在橈骨遠(yuǎn)端AO-C型骨折手術(shù)中選擇掌側(cè)入路與背側(cè)入路兩種手術(shù)方案的臨床療效,探討在治療橈骨遠(yuǎn)端AO-C型骨折中手術(shù)入路的選擇。方法:回顧性分析廣西中醫(yī)藥大學(xué)附屬瑞康醫(yī)院骨四肢科2010年10月至2014年12月間治療的橈骨遠(yuǎn)端骨折患者198例,符合本研究納入標(biāo)準(zhǔn)并完成隨訪的AO-C型橈骨遠(yuǎn)端骨折患者有60例,其中掌側(cè)入路組30例(A組),背側(cè)入路組30例(B組),隨訪時(shí)間為手術(shù)治療后1年;通過比較(1)損傷原因、(2)住院時(shí)間、(3)手術(shù)時(shí)間、(4)X線測(cè)量掌傾角度、尺偏角度、橈骨遠(yuǎn)端高度(5)腕關(guān)節(jié)功能,(6)腕關(guān)節(jié)活動(dòng)度,以比較分析掌側(cè)入路與背側(cè)入路兩組在治療AO-C型橈骨遠(yuǎn)端骨折中各自的臨床療效。統(tǒng)計(jì)數(shù)據(jù)采用統(tǒng)計(jì)軟件(SPSS19.0)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:參加隨訪的患者共68例,其中因術(shù)后失聯(lián)、未按時(shí)復(fù)診等原因而剔除的患者共計(jì)有8例,其中掌側(cè)入路組有5例,背側(cè)入路組有3例。所完成隨訪的患者中未發(fā)現(xiàn)明顯骨折并發(fā)癥,無術(shù)口感染及術(shù)后骨不愈合等情況。完成隨訪的橈骨遠(yuǎn)端骨折患者中骨折類型的比較應(yīng)用卡方檢驗(yàn),X~2=0.281,P=0.8690.05,無統(tǒng)計(jì)學(xué)意義;對(duì)行掌、背側(cè)兩組手術(shù)患者損傷原因行卡方檢驗(yàn),X~2=0.434,P=0.9330.05,無統(tǒng)計(jì)學(xué)意義;掌側(cè)入路組的住院時(shí)間為:14.1±4.09天,手術(shù)時(shí)間為:101.6±22.6min,背側(cè)入路組的住院時(shí)間為:14.3±4.35天,手術(shù)時(shí)間為:104.0±25.5min,對(duì)兩組的住院及手術(shù)平均時(shí)間進(jìn)行比較,均應(yīng)用t檢驗(yàn),住院天數(shù)(P=0.7020.05),手術(shù)時(shí)間(P=0.6970.05),兩項(xiàng)均無統(tǒng)計(jì)學(xué)意義;完成手術(shù)當(dāng)天X線參數(shù),掌側(cè)入路組掌傾角12.2±2.9°、尺偏角21.6±3.5°、橈骨高度11.6±3.9mm,背側(cè)入路組12.2±3.1°、尺偏角21.1±4.1°、橈骨高度11.1±4.1mm,兩組比較,t檢驗(yàn)結(jié)果為:兩組比較掌傾角(P=0.5350.05)、尺偏角(P=0.5150.05)、橈骨高度(P=0.9510.05)三項(xiàng)均無統(tǒng)計(jì)學(xué)意義;完成手術(shù)后12個(gè)月X線參數(shù)掌側(cè)入路組掌傾角12.2±4.0°、尺偏角21.1±5.6°、橈骨高度11.1±3.2mm,背側(cè)入路組10.9±6.0°、尺偏角19.2±7.9°、橈骨高度7.2±4.7mm,兩組比較,應(yīng)用t檢驗(yàn),兩組比較掌傾角(P=0.0230.05)、尺偏角(P=0.0260.05)、橈骨高度(P=0.0370.05)三項(xiàng)均有統(tǒng)計(jì)學(xué)意義;術(shù)后1年時(shí)腕關(guān)節(jié)功能(Gartland-Werley評(píng)分)掌側(cè)入路組2.4±3.2,背側(cè)入路組5.0±5.4,兩組比較,亦應(yīng)用t檢驗(yàn),(P=0.0340.05),有統(tǒng)計(jì)學(xué)意義;術(shù)后1年的腕關(guān)節(jié)活動(dòng)度,掌側(cè)入路組掌屈(51.40±4.25°)、背伸(51.07±2.60°)、橈偏(21.20±1.73°)、尺偏(30.23±2.03°),背側(cè)入路組掌屈(49.13±6.26°)、背伸(49.67±4.81°)、橈偏(21.73±1.66°)、尺偏(31.07±1.87°),兩組比較,亦應(yīng)用t檢驗(yàn),掌屈活動(dòng)度(P=0.7720.05),背伸活動(dòng)度(P=0.1650.05),橈偏活動(dòng)度(P=0.8980.05),尺偏活動(dòng)度(P=0.6310.05),四項(xiàng)均無統(tǒng)計(jì)學(xué)意義。由上說明掌側(cè)入路組與背側(cè)入路在住院時(shí)間,手術(shù)時(shí)間,手術(shù)當(dāng)天X線測(cè)量的掌傾角度、尺偏角度、橈骨遠(yuǎn)端高度及腕關(guān)節(jié)活動(dòng)度等情況上無較大差異,在術(shù)后1年X線測(cè)量的掌傾角度、尺偏角度、橈骨遠(yuǎn)端高度及腕關(guān)節(jié)功能上有較大差異,從術(shù)后1年的恢復(fù)情況看掌側(cè)入路組較背側(cè)入路組更具有優(yōu)勢(shì)。結(jié)論:掌側(cè)入路在術(shù)后1年橈骨遠(yuǎn)端AO-C型骨折手術(shù)后的角度和高度的丟失比背側(cè)入路少,掌側(cè)入路在術(shù)后1年橈骨遠(yuǎn)端AO-C型骨折的腕關(guān)節(jié)功能恢復(fù)優(yōu)于背側(cè)入路,是治療橈骨遠(yuǎn)端AO-C型骨折優(yōu)先選擇的一種手術(shù)入路。
[Abstract]:Objective: to analyze the AO-C type distal radius fracture surgery clinical curative effect of volar metacarpal selection and dorsal approach two operation plans, to explore in the treatment of type AO-C fracture of the distal radius in the choice of surgical approach. Methods: a retrospective analysis of Guangxi traditional Chinese medicine university affiliated Ruikang hospital from October 2010 to December 2014 four limb bone between the treatment of distal radial fractures in patients with 198 cases, in accordance with the inclusion criteria and completed follow-up of type AO-C distal radius fractures in 60 patients, including 30 cases of volar group (A group), dorsal approach group (B group), 30 cases were followed for 1 years after treatment by surgery; compare (1) injury (2), hospitalization time, operation time (3), (4) X-ray measurement of palmar tilt angle, ulnar deviation angle, the height of the distal radius (5) the function of wrist joint, wrist joint activity (6), a comparative analysis of the volar and dorsal approach two groups in the treatment of type AO-C fracture of distal radius. The clinical curative effect respectively. Statistical data using statistical software (SPSS19.0) for statistical analysis. Results: in the follow-up of patients with a total of 68 cases, the cause of postoperative lost, not timely referral reasons such as selecting patients with a total of 8 cases, lateral approach group including 5 cases of palm dorsal approach group in 3 cases. The obvious fracture complications were found in patients with follow-up, no incision infection and postoperative bone nonunion. Complete follow-up in patients with distal radius fractures compared with chi square test, fracture X~2=0.281, P=0.8690.05, no statistical significance; the dorsal palm, the operation of the two groups of patients with injury the reason for the chi square test, X~2=0.434, P=0.9330.05, no statistical significance; hospitalization time palmar lateral approach group: 14.1 + 4.09 days, the operation time is 101.6 22.6min, the time length of the dorsal approach group: 14.3 + 4.35 days, the operation time is 104 25.5min, the two group 鐨勪綇闄㈠強(qiáng)鎵嬫湳騫沖潎鏃墮棿榪涜姣旇緝,鍧囧簲鐢╰媯，

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