不同手术入路治疗桡骨远端AO-C型骨折的疗效分析

发布时间：2018-01-25 12:56

  本文关键词： 桡骨远端骨折 掌侧手术入路 背侧手术入路 功能评价　出处：《广西中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:分析在桡骨远端AO-C型骨折手术中选择掌侧入路与背侧入路两种手术方案的临床疗效,探讨在治疗桡骨远端AO-C型骨折中手术入路的选择。方法:回顾性分析广西中医药大学附属瑞康医院骨四肢科2010年10月至2014年12月间治疗的桡骨远端骨折患者198例,符合本研究纳入标准并完成随访的AO-C型桡骨远端骨折患者有60例,其中掌侧入路组30例(A组),背侧入路组30例(B组),随访时间为手术治疗后1年;通过比较(1)损伤原因、(2)住院时间、(3)手术时间、(4)X线测量掌倾角度、尺偏角度、桡骨远端高度(5)腕关节功能,(6)腕关节活动度,以比较分析掌侧入路与背侧入路两组在治疗AO-C型桡骨远端骨折中各自的临床疗效。统计数据采用统计软件(SPSS19.0)进行统计学分析。结果:参加随访的患者共68例,其中因术后失联、未按时复诊等原因而剔除的患者共计有8例,其中掌侧入路组有5例,背侧入路组有3例。所完成随访的患者中未发现明显骨折并发症,无术口感染及术后骨不愈合等情况。完成随访的桡骨远端骨折患者中骨折类型的比较应用卡方检验,X~2=0.281,P=0.8690.05,无统计学意义;对行掌、背侧两组手术患者损伤原因行卡方检验,X~2=0.434,P=0.9330.05,无统计学意义;掌侧入路组的住院时间为:14.1±4.09天,手术时间为:101.6±22.6min,背侧入路组的住院时间为:14.3±4.35天,手术时间为:104.0±25.5min,对两组的住院及手术平均时间进行比较,均应用t检验,住院天数(P=0.7020.05),手术时间(P=0.6970.05),两项均无统计学意义;完成手术当天X线参数,掌侧入路组掌倾角12.2±2.9°、尺偏角21.6±3.5°、桡骨高度11.6±3.9mm,背侧入路组12.2±3.1°、尺偏角21.1±4.1°、桡骨高度11.1±4.1mm,两组比较,t检验结果为:两组比较掌倾角(P=0.5350.05)、尺偏角(P=0.5150.05)、桡骨高度(P=0.9510.05)三项均无统计学意义;完成手术后12个月X线参数掌侧入路组掌倾角12.2±4.0°、尺偏角21.1±5.6°、桡骨高度11.1±3.2mm,背侧入路组10.9±6.0°、尺偏角19.2±7.9°、桡骨高度7.2±4.7mm,两组比较,应用t检验,两组比较掌倾角(P=0.0230.05)、尺偏角(P=0.0260.05)、桡骨高度(P=0.0370.05)三项均有统计学意义;术后1年时腕关节功能(Gartland-Werley评分)掌侧入路组2.4±3.2,背侧入路组5.0±5.4,两组比较,亦应用t检验,(P=0.0340.05),有统计学意义;术后1年的腕关节活动度,掌侧入路组掌屈(51.40±4.25°)、背伸(51.07±2.60°)、桡偏(21.20±1.73°)、尺偏(30.23±2.03°),背侧入路组掌屈(49.13±6.26°)、背伸(49.67±4.81°)、桡偏(21.73±1.66°)、尺偏(31.07±1.87°),两组比较,亦应用t检验,掌屈活动度(P=0.7720.05),背伸活动度(P=0.1650.05),桡偏活动度(P=0.8980.05),尺偏活动度(P=0.6310.05),四项均无统计学意义。由上说明掌侧入路组与背侧入路在住院时间,手术时间,手术当天X线测量的掌倾角度、尺偏角度、桡骨远端高度及腕关节活动度等情况上无较大差异,在术后1年X线测量的掌倾角度、尺偏角度、桡骨远端高度及腕关节功能上有较大差异,从术后1年的恢复情况看掌侧入路组较背侧入路组更具有优势。结论:掌侧入路在术后1年桡骨远端AO-C型骨折手术后的角度和高度的丢失比背侧入路少,掌侧入路在术后1年桡骨远端AO-C型骨折的腕关节功能恢复优于背侧入路,是治疗桡骨远端AO-C型骨折优先选择的一种手术入路。
[Abstract]:Objective: to analyze the AO-C type distal radius fracture surgery clinical curative effect of volar metacarpal selection and dorsal approach two operation plans, to explore in the treatment of type AO-C fracture of the distal radius in the choice of surgical approach. Methods: a retrospective analysis of Guangxi traditional Chinese medicine university affiliated Ruikang hospital from October 2010 to December 2014 four limb bone between the treatment of distal radial fractures in patients with 198 cases, in accordance with the inclusion criteria and completed follow-up of type AO-C distal radius fractures in 60 patients, including 30 cases of volar group (A group), dorsal approach group (B group), 30 cases were followed for 1 years after treatment by surgery; compare (1) injury (2), hospitalization time, operation time (3), (4) X-ray measurement of palmar tilt angle, ulnar deviation angle, the height of the distal radius (5) the function of wrist joint, wrist joint activity (6), a comparative analysis of the volar and dorsal approach two groups in the treatment of type AO-C fracture of distal radius. The clinical curative effect respectively. Statistical data using statistical software (SPSS19.0) for statistical analysis. Results: in the follow-up of patients with a total of 68 cases, the cause of postoperative lost, not timely referral reasons such as selecting patients with a total of 8 cases, lateral approach group including 5 cases of palm dorsal approach group in 3 cases. The obvious fracture complications were found in patients with follow-up, no incision infection and postoperative bone nonunion. Complete follow-up in patients with distal radius fractures compared with chi square test, fracture X~2=0.281, P=0.8690.05, no statistical significance; the dorsal palm, the operation of the two groups of patients with injury the reason for the chi square test, X~2=0.434, P=0.9330.05, no statistical significance; hospitalization time palmar lateral approach group: 14.1 + 4.09 days, the operation time is 101.6 22.6min, the time length of the dorsal approach group: 14.3 + 4.35 days, the operation time is 104 25.5min, the two group 鐨勪綇闄㈠強鎵嬫湳骞冲潎鏃堕棿杩涜�屾瘮杈�,鍧囧簲鐢╰妫，

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