腕关节镜联合微创锁定钢板内固定治疗AO-B型桡骨远端骨折及关节内精准复位的临床效果评价

Clinical Evaluation of Wrist Arthroscopy Combined with Minimally Invasive Locking Plate Internal Fixation for AO-B Type Distal Radius Fracture and Intra-Articular Precise Reduction

摘要: 目的：探究腕关节镜联合微创锁定钢板内固定治疗AO-B型桡骨远端骨折及关节内精准复位的临床效果。方法：回顾性分析自2016年1月至2018年1月收治我院骨科病房的41例AO-B型桡骨远端的患者，根据手术方案的不同分成两组，即单一方案组18例和联合方案组23例。单一方案组采用单纯微创锁定钢板内固定治疗AO-B型桡骨远端骨折，同时开放性手术处理三角纤维软骨复合体(triangular fibrocartilage complex, TFCC)损伤；联合方案组采用腕关节镜联合微创锁定钢板内固定治疗AO-B型桡骨远端骨折，利用关节镜技术处理TFCC损伤。应用疼痛视觉模拟评分(Visual analogue score, VAS)系统比较两组术前和术后疼痛情况；利用Gartland-Wedey腕关节评分系统和改良Mayo评分系统评价术后腕关节的功能。结果：单一方案组16例患者获得随访，2人失访，随访率为88.9%，联合方案组20例患者获得随访，3人失访，随访率为87.0%，随访时间为8~12个月；两组患者一般基准资料比较无统计学差异(P > 0.05)；联合方案组患者的手术时间要明显长于单一方案组(P < 0.05)；两组患者的手术切口长度，术中出血量和术后引流量比较无统计学差异(P > 0.05)。两组患者术前VAS评分比较无统计学学差异(P > 0.05)；术后1月和术后3月患者VAS评分比较中，联合方案组患者VAS评分要明显高于单一方案组(P < 0.05)；术后6月和术后12月患者VAS评分比较中，单一方案组患者VAS评分要明显高于联合方案组(P < 0.05)；末次随访结果中，联合方案组Gartland-Wedey腕关节功能评分和改良Mayo腕关节评分要明显优于单一方案组(P < 0.05)。两组患者术后血管神经损伤发生率，骨折不愈合发生率和骨折延迟愈合发生率比较无统计学差异(P > 0.05)；联合方案组腕关节僵直发生率要明显低于单一方案组，比较具有统计学差异(P < 0.05)。结论：联合腕关节镜技术修复TFCC的AO-B型桡骨远端骨折内固定方案可以明显改善腕关节功能，具有推广意义。

Abstract: Objective: To explore the clinical effect of wrist arthroscopy combined with minimally invasive locking plate internal fixation in the treatment of AO-B distal radius fracture and intra-articular precise reduction. Methods: This is a retrospective analysis study which was made of 41 patients with AO-B type distal radius who were admitted to the orthopaedic ward of our hospital from January 2016 to January 2018. They were divided into two groups according to the different sur-gical method: the single scheme group (18 cases) and the combined scheme group (23 cases). In the single scheme group, the patient with AO-B type distal radius fracture was treated with minimally invasive locking plate fixation and deal with the TFCC injury through surgery. In the combined scheme group, the patient with AO-B type distal radius fracture was treated with wrist arthroscopy combined with minimally invasive locking plate internal fixation. Visual analogue scoring (VAS) was used to compare the pain symptom preoperative and postoperative pain in the two groups. Gartland-Wedey Wrist Score System and Modified Mayo Score System were used to evaluate the function of wrist joint after operation. Results: Sixteen patients in the single scheme group were followed up, and two patients were lost. The follow-up rate was 88.9%. Twenty patients in the combined scheme group were followed up, and three patients were lost. The follow-up rate was 87.0%. The follow-up period was 8 to 12 months. There was no significant difference in general baseline data between the two groups (P > 0.05). The operation time of the combined scheme group was significantly longer than that of the single scheme group (P < 0.05). There was no statistical difference in VAS score between the two groups before operation (P > 0.05); VAS score of the combined scheme group was significantly higher than that of the single scheme group in 1 month and 3 months after operation (P < 0.05); VAS score of the single scheme group was significantly higher than that of the combined scheme group in 6 months and 12 months after operation (P < 0.05). In the last follow-up, Gartland-Wedey Wrist Function Score and Modified Mayo Wrist Score in the combined scheme group were significantly better than those in the single scheme group (P < 0.05). There was no significant difference in the incidence of vascular and nerve injury, nonunion and delayed union between the two groups (P > 0.05). The incidence of carpal joint stiffness in the combined group was significantly lower than that in the single group (P < 0.05). Conclusion: Combined with wrist arthroscopy for AO-B type distal radius fracture of TFCC can significantly improve wrist joint function, which is worthy of popularization significance.