掌侧小切口联合腕关节镜治疗AO－C型桡骨远端骨折

doi:10.3877/cma.j.issn.1674-134X.2023.04.018

目的

探讨掌侧小切口联合腕关节镜下关节面复位钢板内固定治疗AO-C型桡骨远端骨折的临床疗效。

方法

回顾性分析2018年2月至2020年9月徐州仁慈医院手外科收治的AO-C型桡骨远端骨折患者临床资料。采用腕关节镜联合掌侧1.0~1.5 cm小切口治疗25例(小切口组)，与同期传统Henry入路治疗的17例(传统组)患者随访数据进行独立样本t检验和卡方检验分析，包括两组患者手术切口长度、手术时间、术中出血量和术后第2天腕关节视觉模拟疼痛评分(VAS)，定期随访患者，记录末次随访时腕关节Mayo功能评分，采用Stony-Brook瘢痕评价表(SBSES)评估两组伤口瘢痕情况。

结果

术后小切口组患者均获得随访，平均(12±6)个月，传统组平均随访(13±6)个月。小切口组手术时间长于传统组(t＝6.77)，但小切口组切口长度短于传统组(t＝11.72)，术中出血量少于传统组(t＝10.16)。末次随访时腕关节Mayo评分小切口组高于传统组(t＝3.57)；术后第2天腕关节疼痛VAS评分小切口组低于传统组(t＝2.61)；SBSES法评价切口瘢痕，小切口组优于传统组(t＝3.75)；差异均有统计学意义(均为P<0.05)。

结论

与传统Henry入路相比，关节镜联合掌侧小切口入路内固定治疗AO-C桡骨远端骨折，关节面显露充分、出血少、术后早期疼痛轻、切口瘢痕更美观，但手术时间较传统开放性术式长。

关键词: 桡骨骨折, 关节镜, 骨折固定术，内

Objective

To investigate the clinical efficiency of the treatment of AO-C distal radius fracture with volar minimally invasive approach combined with arthroscopic articular surface reduction plate internal fixation.

Methods

Patients with AO type C distal radius fracture between February 2018 and September 2020 were retrospectively analyzed. The patients were treated with arthroscopic assisted mini- invasive approach in the small incision group(25 patients). The length of incision, operation time, intraoperative blood loss, visual analogue scale(VAS )score of wrist pain on the second day postoperative and the scar of the incision were documented and compared with a traditional Henry approach (traditional group, 17 patients) by independent sample t test and chi-square test were used for comparative analysis.

Results

The patients of small incision group were assessed postoperatively with the average follow-up time of (12±6) months, and the traditional group was followed up for(13±6) months. The operation time in the small incision group was longer than that in the traditional group(t=6.77, P<0.05). Compared to the traditional group, the length of incisions was shorter in the small incision group(t=11.72); there was less blood loss during operation in the small incision group(t=10.16); the Mayo wrist score was higher in the small incision group (t=3.57), and the early postoperative pain VAS score was lower in the small incision group(t=2.61); the Stony Brook scar evaluation scale (SBSES) evaluated the the incision scar was better in the small incision group(t=3.75); the differences were statistically significant (all P<0.05).

Conclusion

Compared with the traditional Henry approach, arthroscopy combined with volar minimally invasive approach internal fixation for the treatment of AO-C distal radius fracture may provide a sufficient exposure of joint, with less blood loss, slight early postoperative pain and less incision scar, but the operation time is longer.

Key words: Radius fracture, Arthroscopy, Fracture fixation, Internal

图1 桡骨远端骨折患者右腕关节术前术后影像、术中腕关节情况及术后随访。图A为术前右腕关节X线正侧位片和CT，示关节面骨折移位明显，AO分型为C型；图B为术中关节镜下复位；图C为术后即刻小切口情况，长度1 cm；图D为术后随访右腕关节X线正侧位片和取出内固定后CT，示关节面恢复良好；图E为末次随访时患者功能恢复情况，Mayo评分95分；图F为手术区域疤痕情况，SBSES(Stony Brook切口瘢痕量表)评分4分

Figure 1 The pre-and post-operative images, intraoperative wrist condition and follow-up information of the patient with distal radius fracture of the right wrist. A is anteroposterior and lateral position X-ray images and CT images of the right wrist, showing obvious displacement of articular surface fracture and AO classification is type C; B is reduction under arthroscope; C is the small incision immediately after surgery, one centimeter of length; D is anteroposterior and lateral positions X-ray and CT images of right wrist after removal of internal fixation, showing the articular surface recovered well; E shows functional recovery of the patient at last follow-up, Mayo score 95; F shows scar in the surgical area, the SBSES score is four

图2 桡骨远端骨折患者右腕关节术前术后影像、术中腕关节情况及术后随访。图A为术前右腕关节正侧位X线片和CT，示关节面骨折移位明显，AO分型为C型；图B为术后即刻伤口情况，长度1.5 cm；图C关节镜下骨折端复位情况，骨折端对位对线良好，台阶<2 mm；图D术后17个月随访X线片和CT，示骨折端愈合良好，关节面恢复良好，无明显台阶；图E术后17个月随访时手术区域瘢痕和功能恢复情况，Mayo评分90分，SBSES(Stony Brook切口瘢痕量表)评分4分

Figure 2 The pre-and post-operative images, intraoperative wrist condition and follow-up information of the patient with distal radius fracture of the right wrist.A is anteroposterior and lateral position X-ray images and CT images of the right wrist, showing obvious displacement of articular surface fracture, and AO classification is type C; B is the small incision immediately after surgery, 1.5 cm in length; C is reduction under arthroscope, showing fracture end alignment is good, step distance is less than two millimeters; D is anteroposterior and lateral positions X-ray and CT images of right wrist at 17 months after operation, showing the fracture end healed well, the articular surface recovered well, and there is no obvious step; E is scar of the surgical area and functional recovery at the 17 months after surgery, Mayo score is 90 and SBSES score is four

表1 小切口组与传统组手术情况及评分比较

Table 1 The surgical datas and scores were compared between the small incision group and the traditional group

组别Groups	例数Case number	手术时间(min) Operation time	切口长度(cm) Length of incisions	出血量(ml) Blood loss	Mayo腕关节评分Mayo wrist score	VAS评分	SBSES评分
小切口组Small incision group	25	109.71±6.50	1.50±0.16	15.37±3.31	92.68±5.02	1.34±1.30	3.22±1.00
传统组Ttraditional group	17	65.00±27.74	5.42±1.45	34.63±7.61	85.97±8.15	2.65±1.61	4.15±0.82
t值		6.77	11.72	10.16	3.57	2.61	3.75
P值		<0.001	<0.001	<0.001	<0.01	0.013	<0.01

表1 小切口组与传统组手术情况及评分比较

Table 1 The surgical datas and scores were compared between the small incision group and the traditional group

组别Groups	例数Case number	手术时间(min) Operation time	切口长度(cm) Length of incisions	出血量(ml) Blood loss	Mayo腕关节评分Mayo wrist score	VAS评分	SBSES评分
小切口组Small incision group	25	109.71±6.50	1.50±0.16	15.37±3.31	92.68±5.02	1.34±1.30	3.22±1.00
传统组Ttraditional group	17	65.00±27.74	5.42±1.45	34.63±7.61	85.97±8.15	2.65±1.61	4.15±0.82
t值		6.77	11.72	10.16	3.57	2.61	3.75
P值		<0.001	<0.001	<0.001	<0.01	0.013	<0.01

[1]	蒋华军，苑海洋，刘司达，等. 桡骨远端关节内骨折Doi分型临床应用的可行性研究[J]. 中华手外科杂志，2020, 36(5): 365-368.
[2]	姜保国，龙奎元，张殿英，等. 桡骨远端骨折的治疗策略[J]. 中华创伤骨科杂志，2004(10): 1118-1121.
[3]	李双，邓爱东，顾晓坤，等. C型桡骨远端骨折的骨折形态和桡尺远端韧带的影像学研究[J]. 中华手外科杂志，2020, 36(2): 114-118.
[4]	王晓峰，滕晓峰，薛建波，等. 腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折[J]. 中华手外科杂志，2021, 37(1): 44-47.
[5]	郑上团，吴斗，郝海虎，等. 桡骨远端骨折的治疗进展[J]. 中华骨科杂志，2016, 36(5): 314-320.
[6]	杨顺，程亚博. 腕关节镜辅助下治疗桡骨远端骨折的疗效观察[J]. 中华手外科杂志，2020, 36(2): 131-133.
[7]	Fearmonti R, Bond J, Erdmann D, et al. A review of scar scales and scar measuring devices[J/OL]. Eplasty, 2010, 10: e43. URL
[8]	苏日宝，王培吉，王秀会，等. 快速康复外科理论在老年桡骨远端骨折手术治疗中的应用[J]. 中华手外科杂志，2018, 34(5): 338-341.
[9]	Lebailly F, Zemirline A, Facca S, et al. Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases[J]. Eur J Orthop Surg Traumatol, 2014, 24(6): 877-890.
[10]	Abe Y. Plate presetting and arthroscopic reduction technique (PART) for treatment of distal radius fractures[J]. Handchir Mikrochir Plast Chir, 2014, 46(5): 278-285.
[11]	刘波. 腕关节损伤治疗相关争议问题探讨[J]. 中华创伤杂志，2018, 34(9): 769-772.
[12]	刘波，陈山林，朱瑾，等. 干关节镜技术在腕关节镜治疗腕关节损伤中的疗效评价[J]. 中华创伤杂志，2019, 35(3): 241-246.
[13]	樊健，张鑫，毛也然，等. 腕关节镜辅助下治疗复杂桡骨远端骨折[J]. 中华解剖与临床杂志，2018, 23(2): 104-109.
[14]	叶钢，肖兢，汪洲，等. 腕关节镜辅助下桡骨远端C型骨折有限切开复位内固定的临床疗效评价[J]. 中华手外科杂志，2018, 34(1): 4-6.
[15]	徐文东，尹华伟，顾玉东. 重视腕关节骨与韧带损伤微创化与精准化治疗[J]. 中华创伤杂志，2020, 36(2): 137-142.

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Treatment of AO-C distal radius fractures with volar minimally invasive approach combined with wrist arthroscopy

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Treatment of AO-C distal radius fractures with volar minimally invasive approach combined with wrist arthroscopy