传统手术及腕关节镜微创治疗不稳定性桡骨远端骨折的临床比较

Clinical efficacy of traditional open reduction and internal fixation versus minimally invasive wrist arthroscopy in treatment of unstable distal radius fracture

摘要:

目的：对比分析传统切开复手术及腕关节镜微创手术治疗不稳定性桡骨远端骨折的临床疗效差异。方法：纳入2014年1月至2016年12月于我院接受治疗的86例不稳定性桡骨远端骨折患者为对象，按手术方案分组，观察组（41例）接受腕关节镜微创手术，对照组（45例）接受传统切开复位内固定手术。对比2组骨折愈合时间，治疗前及治疗3个月后掌倾角、尺偏角、桡骨短缩量、改良Sarmiento评分变化情况，末次随访时改良Gartland-Werley腕关节功能评分、腕关节活动度及并发症发生情况。结果：2组骨折愈合时间，治疗前及治疗3个月后掌倾角、尺偏角、桡骨短缩量、改良Sarmiento评分对比，差异均无统计学意义（P ＞0.05）。末次随访时，观察组腕关节功能优于对照组，腕关节各方向活动度均优于对照组，差异有统计学意义（P＜0.05）。随访期间，观察组发生关节面不平整及（创伤性）关节炎者少于对照组，差异有统计学意义（P＜0.05）。结论：腕关节镜微创手术治疗不稳定性桡骨远端骨折，可获得与传统切开复位手术相近的近期骨折复位效果，但在骨折愈合后腕关节功能恢复上更具有优势，推荐临床应用。

Abstract:

Objective：To investigate the clinical efficacy of traditional open reduction and internal fixation versus minimally invasive wrist arthroscopy in the treatment of unstable distal radius fracture. Methods：Eighty-six patients with unstable distal radial fracture who underwent surgery in our hospital from January 2014 to December 2016 were enrolled in this study. They were divided into ob－servation group（n=41） and control group（n=45） according to different operation methods. The observation group underwent minimally invasive wrist arthroscopy，while the control group underwent traditional open reduction and internal fixation. The following indices were compared between the two groups：fracture healing time，the volar tilt angle，ulnar inclination angle，radial shortening，and modi－fied Sarmiento score before surgery and at 3 months after surgery，and the modified Gartland-Werley wrist function score and wrist joint range of motion at the last follow-up，as well as the incidence of complications. Results：There were no significant differences in fracture healing time and the volar tilt angle，ulnar inclination angle，radial shortening，and modified Sarmiento score before surgery and at 3 months after surgery between the two groups（P >0.05）. Compared with the control group，the observation group had significantly better wrist function and wrist joint range of motion in all directions at the last follow-up（P<0.05）；the observation group had significantly lower incidence rates of joint surface roughness and （traumatic） arthritis during the follow-up（P <0.05）. Conclusion：Minimally invasive wrist arthroscopy can achieve similar recent fracture reduction to traditional open reduction and internal fixation in the treatment of unstable distal radius fracture，but it has an ad－vantage in recovery of wrist function after fracture healing. Therefore，it holds promise for clinical application.