比较腕关节镜与术中透视切开复位掌侧钢板内固定治疗桡骨远端关节内骨折的临床效果。

回顾分析2020年4月至2023年4月在安康市中心医院进行手术治疗的151例桡骨远端关节内骨折患者临床资料，根据辅助治疗方式不同分成传统组（传统术中透视辅助）78例，关节镜组（腕关节镜辅助）73例。记录两组术中出血量住院时间、骨折愈合时间、手术时间、上肢功能评定表（DASH）、腕关节功能患者自行评估量表（PREW）、腕关节活动范围、全血低切粘度、全血高切粘度及血浆粘度变化；记录并计算并发症发生率。采用独立样本t检验、卡方检验对数据进行统计学分析。

关节镜组术中出血量显著少于传统组，住院时间及骨折愈合时间均明显短于传统组，但手术时间长于传统组（t=2.954、3.231、5.432、3.383，均为P<0.05）。术后6个月，关节镜组DASH、PREW得分均明显低于传统组，屈曲、旋前、旋后、尺侧、桡侧及背伸活动度均明显高于传统组（t=2.903、2.261、2.265、2.283、2.190、3.976、6.105、3.289，均为P<0.05）；术后12个月，两组DASH、PREW得分均降低，屈曲、旋前、旋后、尺侧、桡侧及背伸活动度均上升，但两组组间差异没有统计学意义（t=1.919、0.527、0.807、0.438、1.003、1.202、1.009、1.049，均为P>0.05）。术后3个月，两组全血低切粘度、全血高切粘度及血浆粘度均降低，且关节镜组均明显低于传统组（t=3.123、2.082，均为P<0.05）。两组不良反应发生率比较差异没有统计学意义（P=0.444）。

治疗桡骨远端关节内骨折，关节镜辅助下术中出血量更少，更有利于骨折愈合，改善近期腕关节功能，减少对机体微循环的影响。

To compare clinical effects between wrist arthroscopy and intraoperative fluoroscopy assisted open reduction and volar plate internal fixation in the treatment of intra-articular distal radius fractures.

A retrospective analysis was conducted on the clinical data of 151 patients with intra-articular distal radius fractures who received surgical treatment in Ankang Central Hospital from April 2020 to April 2023. According to different adjuvant treatment methods, the patients were divided into the traditional group (traditional intraoperative fluoroscopy assisted surgery, 78 cases) and the arthroscope group (wrist arthroscope assisted surgery, 73 cases). Intraoperative blood loss, length of hospital stay, fracture healing time, duration of surgery, the disabilities of the arm, shoulder and hand (DASH) scores, patient-rated wrist examination (PRWE) scores, wrist range of motion, whole blood low shear viscosity, whole blood high shear viscosity and plasma viscosity of the two groups were recorded. The complication incidence was also recorded. The independent-sample t test and chi square test were used for statistical analysis.

Intraoperative blood loss, length of hospital stay and fracture healing time of the arthroscope group were significantly less and shorter than those of the traditional group, but the duration of surgery was significantly longer than that in the traditional group (t=2.954, 3.231, 5.432, 3.383, all P<0.05). Six months after surgery, DASH and PREW scores of the arthroscope group were significantly lower than those of the traditional group. The ranges of flexion, pronation and supination, ulnar and radial ranges of motion, and range of dorsiflexion were significantly larger than those in the traditional group (t=2.903, 2.261, 2.265, 2.283, 2.190, 3.976, 6.105, 3.289, all P<0.05). Twelve months after surgery, there were decreases in DASH and PREW scores, and increases in the ranges of flexion, pronation and supination, ulnar and radial ranges of motion, and the range of dorsiflexion in both groups. However, there was no statistically significant difference between the groups (t=1.919, 0.527, 0.807, 0.438, 1.003, 1.202, 1.009, 1.049, all P>0.05). Three months after surgery, whole blood low shear viscosity, whole blood high shear viscosity and plasma viscosity in both groups decreased, and these indicators in the arthroscope group were significantly lower than those in the traditional group (t=3.123, 2.082, both P<0.05). The incidence of adverse reactions showed no statistically significant difference between groups (P=0.444).

For intra-articular distal radius fracture, wrist arthroscopy assisted surgery causes less intraoperative blood loss, and is more conducive to fracture healing. It can improve short-term wrist function, and reduce the impact on microcirculation in the body.