研究腕关节镜辅助切开复位内固定治疗桡骨远端骨折治疗中的效果。

本研究为前瞻性研究，选取研究对象为绵阳市骨科医院2014年1月到2018年12月接治的82例桡骨远端骨折患者，纳入病例均经腕关节CT和X线提示桡骨远端骨折，国际内固定研究协会(AO)分型为C型骨折，且由外伤所致，均累及关节面，并为单侧损伤。排除陈旧性骨折者，严重骨质疏松及合并其他骨折者，重要脏器功能异常者，精神疾病者。按随机数字表法将患者分为研究组42例和对照组40例，其中研究组给予腕关节镜辅助下切开复位内固定术，对照组给予传统切开复位钢板内固定术。评定两组临床疗效，并采用卡方检验比较其差异。记录两组术中指标及骨折愈合时间，测定两组术前、术后1年腕关节活动度，同时采用上肢功能评定量表(DASH)、腕关节自行评估量表(PRWE)对两组术前、术后1年上肢功能、腕关节功能进行评定，并采用t检验比较组间计量资料差异。

研究组治疗后优良率为92.9 %，远高于对照组优良率75.0 %(χ²＝4.897，P<0.05)。研究组手术时间明显长于对照组(t＝7.329，P<0.05)，但术中出血量显著少于对照组(t＝12.230，P<0.05)；两组骨折愈合时间比较差异无统计学意义(t＝1.843，P>0.05)。研究组术后DASH评分、PRWE评分均明显低于对照组(t＝10.196、5.771，均为P<0.05)。术后1年，研究组患者腕关节掌屈、背伸、桡偏、尺偏、旋前、旋后等活动范围及握力均优于对照组，两组间各项指标比较差异均具有统计学意义(P<0.05)。

对桡骨远端骨折患者应用腕关节镜辅助下切开复位内固定术治疗效果显著，可促进骨折愈合，尽快改善患者上肢功能及腕关节功能，提高腕关节活动度。

To study the effect of wrist arthroscopy assisted open reduction and internal fixation in the treatment of distal radius fractures.

This study was a prospective study. A total of 82 patients with distal radius fracture who were treated in Mianyang Orthopedic Hospital from January 2014 to December 2018 were selected as the study subjects, all the patients were diagnosed as distal radius fractures by wrist joint CT and X-ray. Association for the Study of Internal Fixation(AO)classification was type C fracture, which was caused by trauma, involving articular surface and unilateral injury. Patients with old fracture, severe osteoporosis and other fractures, abnormal function of important organs and mental illness were excluded.According to random number table method, the patients were divided into study group (n=42) and control group (n=40), in which the study group received carpal arthroscopic assisted open reduction and internal fixation, and the control group received traditional open reduction and plate internal fixation.The clinical efficacy of the two groups was evaluated, and the difference was compared by chi square test. The intraoperative indexes and fracture healing time of the two groups were recorded or counted, and the range of motion of wrist joint was measured before and one year after the operation in the two groups. The upper limb function assessment scale (DASH) and wrist joint self assessment scale (PRWE) were used to evaluate the upper limb function and wrist joint function of the two groups before and one year after the operation, and the data were collected t test was used to compare the difference of measurement data between groups.

The excellent and good rate of the study group was 92.9%, which was much higher than that of the control group (75.0%) (χ²=4.897, P<0.05). The operation time of the study group was significantly longer than that of the control group(t=7.329, P<0.05), but the intraoperative hemorrhage was significantly less than that of the control group (t=12.230, P<0.05); there was no significant difference in fracture healing time between the two groups (t=1.843, P>0.05). The scores of DASH and PRWE in the study group were significantly lower than those in the control group (t=10.196, 5.771, both P<0.05). One year after the operation, the range of motion of wrist in palmar flexion, back extension, radial deviation, ulnar deviation, pronation, supination, and the grip strength of the patients in the study group were better than those in the control group, and there were significant differences between the two groups (P<0.05).

The open reduction and internal fixation with the assistance of wrist arthroscope is effective in the treatment of distal radius fracture, which can promote fracture healing, improve the function of upper limb and wrist joint as soon as possible, and improve the mobility of wrist joint.