【摘要】：目的:通過回顧性分析分別經(jīng)改良Henry入路和傳統(tǒng)Henry入路結(jié)合Acu-Loc掌側(cè)鎖定骨板系統(tǒng)治療復(fù)雜型橈骨遠端骨折的臨床效果,旨在探討改良后的Henry入路和Acu-Loc掌側(cè)鎖定骨板系統(tǒng)在治療橈骨遠端不穩(wěn)定性骨折的手術(shù)優(yōu)勢和術(shù)后療效,為進一步提高不穩(wěn)定型橈骨遠端骨折的診治質(zhì)量提供理論依據(jù)。方法:選取2014年4月-2016年6月間由吉林大學(xué)中日聯(lián)誼醫(yī)院骨科接診并最終行手術(shù)治療的50例橈骨遠端不穩(wěn)定性骨折患者,按亂數(shù)表法將患者隨機分為改良Henry入路組和傳統(tǒng)Henry入路組,每組各25例患者,改良Henry入路組采用改良后的Henry手術(shù)入路結(jié)合Acu-Loc掌側(cè)鎖定骨板系統(tǒng)治療;傳統(tǒng)Henry入路組采用傳統(tǒng)的Henry手術(shù)入路結(jié)合Acu-Loc掌側(cè)鎖定骨板系統(tǒng)治療。術(shù)后均定期復(fù)查患側(cè)腕關(guān)節(jié)正側(cè)位X線片,觀察橈骨遠端關(guān)節(jié)面并測量掌傾角、尺偏角及橈骨短縮數(shù)值與術(shù)前對比,分別對照改良的Mcbride腕關(guān)節(jié)功能評估標(biāo)準(zhǔn)及Dienst腕關(guān)節(jié)功能評估標(biāo)準(zhǔn),評價手術(shù)后患側(cè)腕關(guān)節(jié)的功能恢復(fù)情況,并記錄術(shù)中情況和術(shù)后并發(fā)癥等。將所得數(shù)據(jù)進行統(tǒng)計學(xué)處理,以α=0.05為檢驗水準(zhǔn),P0.05差異有統(tǒng)計學(xué)意義。比較兩組間的臨床療效和各組內(nèi)手術(shù)前后的差異。結(jié)果:術(shù)后所有患者切口都甲級愈合,均配合隨訪,隨訪時間6-24個月,平均隨訪時間為(11.7士4.8)個月。術(shù)后半年,拍攝X線片結(jié)果顯示,兩組患者手術(shù)后的橈骨遠端關(guān)節(jié)面均較為平整,橈骨無明顯軸向短縮,內(nèi)植物位置良好、未發(fā)現(xiàn)內(nèi)固定物折斷、無創(chuàng)傷性關(guān)節(jié)炎、無骨折延期愈合或骨折不愈合發(fā)生。兩組患者與術(shù)前相比均獲得了有效的治療。腕關(guān)節(jié)功能評分及優(yōu)良率方面,改良Henry入路組Dienst腕關(guān)節(jié)功能評估的優(yōu)良率為96.00%(24/25),略高于傳統(tǒng)Henry入路組的92.00%(23/25),但差異無統(tǒng)計學(xué)意義(P0.05);改良Henry入路組對照改良Mcbride腕關(guān)節(jié)功能評估標(biāo)準(zhǔn)的優(yōu)良率為96.00%(24/25),而傳統(tǒng)Henry入路組為92.00%(23/25),改良組仍高于傳統(tǒng)組,但差異無統(tǒng)計學(xué)意義(P0.05)。在解剖角度方面,兩組術(shù)后的掌傾角、尺偏角及橈骨高度無明顯差異(P0.05);術(shù)后兩組內(nèi)的掌傾角、尺偏角及橈骨高度均較術(shù)前有明顯改善(P0.05),差異有統(tǒng)計學(xué)意義。術(shù)中情況,改良Henry入路組與傳統(tǒng)Henry入路組相比,前者的手術(shù)用時和骨折愈合周期均較短,且術(shù)中旋前方肌修復(fù)率高,術(shù)后正中神經(jīng)刺激率低,差異均有統(tǒng)計學(xué)意義。結(jié)論:Acu-Loc橈骨遠端掌側(cè)鎖定骨板系統(tǒng)治療復(fù)雜型橈骨遠端骨折,術(shù)中操作更加靈活便捷,骨折復(fù)位滿意,固定牢靠,有效縮短手術(shù)時間,術(shù)后腕關(guān)節(jié)功能恢復(fù)良好,允許患肢早期從事輕度日�；顒�;改良Henry入路和傳統(tǒng)Henry入路均能有效顯露骨折,利于術(shù)中操作并有足夠空間安置鋼板,但改良Henry入路對旋前方肌損傷小,在使用相同內(nèi)固定物的情況下,其術(shù)后相關(guān)并發(fā)癥發(fā)生率低,患者良性主觀回饋率高,值得在臨床上進一步推廣使用。
[Abstract]:Objective: to analyze the clinical effect of modified Henry approach and traditional Henry approach combined with Acu-Loc metacarpal locking bone plate system in the treatment of complex distal radius fractures. The purpose of this study was to investigate the surgical advantages and postoperative efficacy of modified Henry approach and Acu-Loc metacarpal locking bone plate system in the treatment of unstable distal radius fractures, and to provide theoretical basis for further improving the quality of diagnosis and treatment of unstable distal radius fractures. Methods: from April 2014 to June 2016, 50 patients with unstable distal radius fractures were randomly divided into modified Henry approach group (n = 25) and traditional Henry approach group (n = 25). The modified Henry approach group was treated with modified Henry approach combined with Acu-Loc palmally locked bone plate system. The traditional Henry approach group was treated with traditional Henry approach combined with Acu-Loc palmally locked bone plate system. The anterior and lateral radiographs of the affected wrist were reviewed regularly after operation. The distal radius joint surface was observed and the metacarpal inclination angle, ulna deviation angle and radius shortening were measured compared with those before operation. The improved Mcbride wrist joint function evaluation standard and Dienst wrist joint function evaluation standard were compared, and the functional recovery of the affected wrist joint after operation was evaluated, and the intraoperative situation and postoperative complications were recorded. The data were statistically processed, and 偽 = 0.05 was used as the test level, and the difference was statistically significant (P 0.05). The clinical efficacy of the two groups and the difference between the two groups before and after operation were compared. Results: all the incisions healed in grade A after operation, and all of them were followed up for 6 to 24 months, with an average follow-up time of (11.7 鹵4.8) months. Half a year after operation, the results of X-ray film showed that the distal radius joint surface of the two groups was smooth, there was no obvious axial shortening of radius, the position of internal plant was good, no internal fixation was broken, no traumatic arthritis was found, and no delayed union or nonunion of fracture occurred. Both groups received effective treatment compared with preoperative treatment. In terms of wrist function score and excellent and good rate, the excellent and good rate of Dienst wrist function evaluation in modified Henry approach group was 96.00% (24 鈮，

本文編號：2509172