中国修复重建外科杂志

中国修复重建外科杂志

腕关节镜辅助治疗关节内桡骨远端骨折的早期疗效观察

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目的探讨腕关节镜辅助治疗关节内桡骨远端骨折的早期疗效。方法回顾分析 2015 年 1 月—2017 年 12 月收治的 50 例关节内桡骨远端骨折患者临床资料,根据术中辅助治疗方式不同将患者分为试验组(11 例,采用腕关节镜辅助治疗)和对照组(39 例,采用传统切开复位)。两组患者性别、年龄、侧别、致伤原因、受伤至手术时间以及术前移位程度等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。试验组术中 6 例发现三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)损伤予以一期修复。术后 1 d 摄 X 线片对骨折复位情况进行评价。术后 3 个月采用腕关节功能自我评定表(Patient-Rated Wrist Evaluation,PRWE)和腕关节改良 Mayo 评分评价功能。记录并比较两组患者术后 3 个月腕关节屈曲、伸展、旋前、旋后活动度;并将试验组患者再分为关节镜探查后复位组(A 组,6 例)和关节镜探查后单纯清理组(B 组,5 例),比较其各向活动度。结果试验组手术时间长于对照组(t=11.08,P=0.00);两组患者术中出血量和骨折复位情况比较差异无统计学意义(P>0.05)。术后第 1 天复查 X 线片发现两组骨折移位程度均较术前显著减小(P<0.05);但两组间比较差异无统计学意义(t=0.19,P=0.85)。两组患者均获随访,随访时间 8~20 个月,平均 12 个月。两组骨折愈合时间比较差异无统计学意义(t=0.52,P=0.60)。术后 3 个月,试验组 PRWE 评分、腕关节改良 Mayo 评分和腕关节各向活动度均优于对照组(P<0.05);试验组内 A、B 两组腕关节各向活动度比较,差异均无统计学意义(P>0.05)。结论腕关节镜辅助治疗桡骨远端关节内骨折可以使患者获良好复位和术后功能,且可一期修补 TFCC、韧带、关节软骨等损伤。

ObjectiveTo investigate the early-term effectiveness of carpal arthroscopy in the treatment of intra-articular fractures of distal radius.MethodsThe clinical data of 50 cases of intra-articular fractures of distal radius between January 2015 and December 2017 were retrospectively analyzed. According to the different methods of intraoperative assisted treatment, the patients were divided into the trial group (11 cases with carpal arthroscopy assisted treatment) and the control group (39 cases with traditional open reduction). There was no significant difference between the two groups in general data such as gender, age, affected side, cause of injury, time from injury to operation, and preoperative displacement (P>0.05), which were comparable. Six patients in the trial group had triangular fibrocartilage complex (TFCC) injury and received one-stage repair. Postoperative X-ray films were taken to estimate the fracture reduction. Patient-Rated Wrist Evaluation (PRWE) wrist function score and modified Mayo score were used at 3 months after operation to evaluate the function of the wrist. The range of wrist flexion, extension, pronation, and supination motion of the two groups were recorded and compared at 3 months after operation. Patients in the trial group were further divided into the reduction group after arthroscopic exploration (group A, 6 cases) and the simple cleaning group after arthroscopic exploration (group B, 5 cases), and their wrist motions were compared.ResultsThe operation time of the trial group was greater than that of the control group (t=11.08, P=0.00). There was no significant difference in intraoperative blood loss and fracture reduction between the two group (P>0.05). X-ray film at 1 day after operation showed that the degree of fracture displacement was significantly decreased when compared with preoperative one in each group (P<0.05), but no significant difference was found between the two groups at 1 day after operation (t=0.19, P=0.85). Patients in both groups were followed up 8-20 months, with an average of 12 months. There was no significant difference in fracture healing time between the two groups (t=0.52, P=0.60). At 3 months after operation, the PRWE score, modified Mayo score, and wrist motions in the trial group were all better than those in the control group (P<0.05). There was no significant difference in wrist motions between group A and group B (P>0.05).ConclusionCarpal arthroscope assisted treatment of intra-articular fractures of distal radius can achieve good reduction and postoperative function. Meanwhile, TFCC, ligament, articular cartilage, and other injuries can be repaired in one stage.

关键词: 腕关节镜; 关节内骨折; 桡骨远端骨折; 功能评价

Key words: Carpal arthroscope; intra-articular fracture; distal radius fracture; function evaluation

引用本文: 方凯彬, 王文怀. 腕关节镜辅助治疗关节内桡骨远端骨折的早期疗效观察. 中国修复重建外科杂志, 2019, 33(2): 138-143. doi: 10.7507/1002-1892.201807038 复制

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