摘要
目的研究掌侧入路经皮微创钢板内固定术(MIPPO)术中保留旋前方肌对桡骨远端骨折(DRF)患者腕关节功能恢复及预后的影响。方法选择2022年1月—2024年1月本院收治的104例DRF患者作为研究对象,依照随机化分组法分为不保留组和保留组两组,每组各52例。不保留组实施掌侧入路MIPPO,术中不保留旋前方肌,保留组实施掌侧入路MIPPO术中保留旋前方肌治疗。比较两组手术指标(手术时间、术中出血量、住院时间)、术后恢复情况(治疗有效率、术后并发症发生率、术后骨折愈合时间),对比术前、术后1个月两组患者的腕关节活动范围,观察术后1个月、3个月、6个月、12个月两组患者的腕关节功能(Gartland-Werley腕关节评分)以及预后情况[上肢功能障碍评定量表(DASH)]。结果保留组手术时间、术中出血量、住院时间均低于不保留组(P<0.05)。两组治疗有效率比较差异无统计学意义(P>0.05),保留组术后并发症发生率、术后骨折愈合时间低于不保留组(P<0.05)。术后1个月,两组患者腕关节活动范围较术前均有显著升高(P<0.05),且保留组患者腕关节活动范围高于不保留组(P<0.05)。术后恢复期间两组患者Gartland-Werley评分、DASH评分均呈降低趋势(P<0.05),且术后1个月、3个月、6个月、12个月保留组上述评分明显低于不保留组(P<0.05)。结论掌侧入路MIPPO术中保留旋前方肌对DRF患者具有较高的治疗效果,相较于术中不保留旋前方肌,手术时间更短,术后恢复更快,且能保持较高的腕关节活动度,更有利于维持远期腕关节功能和预后肢体活动功能,具有较高临床应用价值。
Objective To investigate the impact of preserving the pronator quadratus muscle during minimally invasive percutaneous plate osteosynthesis(MIPPO)via the volar approach on the recovery of wrist joint function and prognosis in patients with distal radius fractures(DRF).Methods A total of 104 patients with DRF admitted to Puyang Oilfield General Hospital from January 2022 to January 2024 were randomly divided into a non-preservation group and a preservation group,with 52 cases in each group.The non-preservation group underwent volar approach MIPPO without preserving the pronator quadratus muscle,while the preservation group underwent volar approach MIPPO with preservation of the pronator quadratus muscle.Surgical indicators(operation time,intraoperative blood loss,hospital stay),postoperative recovery(treatment effective rate,postoperative complication rate,postoperative fracture healing time),and wrist joint range of motion before surgery and 1 month after surgery were compared between the two groups.The wrist joint function(Gartland-Werley wrist joint score)and prognosis[Disabilities of the Arm,Shoulder and Hand(DASH)score]of the two groups were evaluated at 1,3,6,and 12 months after surgery.Results The operation time,intraoperative blood loss,and hospital stay in the preservation group were all lower than those in the non-preservation group(P<0.05).There was no statistically significant difference in the treatment effective rate between the two groups(P>0.05).The postoperative complication rate and postoperative fracture healing time in the preservation group were lower than those in the non-preservation group(P<0.05).One month after surgery,the wrist joint range of motion in both groups was significantly increased compared with that before surgery(P<0.05),and the wrist joint range of motion in the preservation group was higher than that in the non-preservation group(P<0.05).During the postoperative recovery period,the Gartland-Werley score and DASH score of both groups showed a decreasing trend(P<0.05),and the above scores in the preservation group were significantly lower than those in the non-preservation group at 1,3,6,and 12 months after surgery(P<0.05).Conclusions Preserving the pronator quadratus muscle during volar approach MIPPO has a higher therapeutic effect on DRF patients.Compared with not preserving the pronator quadratus muscle during surgery,it has a shorter operation time,faster postoperative recovery,and can maintain a higher wrist joint range of motion,which is more conducive to maintaining long-term wrist joint function and limb activity function,and has high clinical application value.
作者
王丙超
赵振举
王振江
Wang Bingchao;Zhao Zhenju;Wang Zhenjiang(Department of Hand-Foot and Trauma Orthopedics(The Third Ward of Orthopedics Department),Puyang Oilfield General Hospital,Puyang,Henan 457000,China)
出处
《齐齐哈尔医学院学报》
2025年第16期1525-1529,共5页
Journal of Qiqihar Medical University
关键词
掌侧入路
经皮微创钢板内固定
旋前方肌
桡骨远端骨折
腕关节功能
Volar approach
Percutaneous minimally invasive plate fixation
Pronator quadratus
Distal radius fracture
Wrist function
