摘要
目的 分析微创经皮钢板骨桥接术(MIPPO)联合内固定锁定系统对于桡骨远端C1型骨折患者的临床价值。方法 选取2024年7月—2025年1月收治的桡骨远端骨折患者80例,采用随机数字表法分为对照组和观察组,每组各40例。对照组行桡骨远端常规Henry入路,观察组行MIPPO入路,全部研究对象均使用多轴锁定系统进行内固定,对比两组手术时间、出血量及并发症发生率,对比术后2、4、8、12周疼痛[视觉模拟评分法(VAS)评分]及腕关节功能(Gartland-Werley评分),并对比末次随访时两组骨折愈合时间、上肢功能(DASH评分)及腕关节活动度。结果 观察组手术时间(t=47.131, P<0.001)、出血量(t=13.09, P<0.001)均低于对照组,并发症发生率也低于对照组(χ^(2)=3.105, P=0.078)。术后2、4周时,观察组的VAS评分显著低于对照组(t=-4.852、-4.733, P<0.001);术后8周和12周,两组间VAS评分无显著差异(t=-1.826、1.043, P=0.073、0.301)。术后2周(t=-3.642, P=0.001)、4周(t=-5.195, P<0.001)、8周(t=-5.240, P<0.001)时,观察组Gartland-Werley评分高于对照组;术后12周时,两组Gartland-Werley评分无显著差异(t=-0.375, P=0.709)。末次随访时,两组骨折愈合时间(t=0.793, P=0.431)、DASH评分(t=1.171, P=0.246)及腕关节活动度[屈曲(t=1.386, P=0.171)、伸直(t=-0.631, P=0.531)、桡偏(t=-1.377, P=0.174)、尺偏(t=-1.53, P=0.131)]均无显著差异。结论 桡骨远端骨折患者应用MIPPO联合内固定锁定系统进行治疗,不仅手术时间短、出血量少、并发症发生率较低,且手术疼痛可缓解、腕关节功能恢复佳。提示MIPPO联合内固定锁定系统在改善桡骨远端骨折患者的短期手术效果和功能恢复方面具有较高的临床应用价值。
Objective To evaluate the clinical efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)combined with an internal fixation locking system in patients suffering from type C distal radius fractures.Methods This study involved 80 patients with distal radius fractures admitted between July 2024 and January 2025.These patients were randomly assigned to either a control group or an observation group,with 40 patients in each group.The control group underwent the Henry approach to the distal radius,while the observation group received the MIPPO approach.Both groups were treated with internal fixation using the palmar multi-axial locking system.Comparisons were made between the two groups regarding operation duration,blood loss,and complication incidence.Additionally,comparisons included postoperative pain(visual analogue scale,VAS),carpal function(Gartland-Werley score)at 2,4,8,and 12 weeks post-surgery,as well as fracture healing time,upper limb function(DASH score),and wrist mobility at the final follow-up.Results The observation group demonstrated significantly shorter operation time(t=47.131;P<0.001)and reduced blood loss(t=13.09;P<0.001)compared to the control group.The complication rate was also lower in the observation group,though not statistically significant(χ^(2)=3.105;P=0.078).At 2 weeks and 4 weeks postoperatively,the VAS scores of the observation group were significantly lower than those of the control group(t=-4.852,-4.733;P<0.001);there was no significant difference in the VAS scores of the two groups at 12 weeks and 24 weeks postoperatively(t=-1.826,1.043;P=0.073,0.301).At 2 weeks(t=-3.642;P=0.001),4 weeks(t=-5.195;P<0.001),and 8 weeks(t=-5.240;P<0.001)postoperatively,the Gartland-Werley scores of the observation group were higher than those of the control group,and the Gartland-Werley scores of the two groups were not significantly different at 12 weeks postoperatively(t=-0.375;P=0.709).At the final follow-up,fracture healing time(t=0.793;P=0.431),DASH score(t=1.171;P=0.246),and wrist mobility in terms of flexion(t=1.386;P=0.171),extension(t=-0.631;P=0.531),radial deviation(t=-1.377;P=0.174),and ulnar deviation(t=-1.53;P=0.131)showed no significant differences between the two groups.Conclusion Treating distal radius fracture with the MIPPO approach combined with an internal fixation locking system results in short operation time,reduced bleeding,few complications,little postoperative pain,and good wrist function recovery.MIPPO combined internal fixation locking system proves highly valuable in enhancing short-term surgical results and functional recovery for patients with distal radius fracture.
作者
唐熙晨
郑军
李亨
王庚启
TANG Xichen;ZHENG Jun;LI Heng;WANG Gengqi(Department of Traumatology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)
基金
上海市体育局科技创新项目(KY111.30.136)。
关键词
微创经皮钢板骨桥接术
内固定锁定系统
桡骨远端骨折
临床价值
Minimally invasive percutaneous plate osteosynthesis
Internal fixation locking system
Distal radius fracture
Clinical value
