Fang Kaibin, Wang Wenhuai
Department of Orthopedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China.
Department of Orthopedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Feb 15;33(2):138-143. doi: 10.7507/1002-1892.201807038.
To investigate the early-term effectiveness of carpal arthroscopy in the treatment of intra-articular fractures of distal radius.
The clinical data of 50 cases of intra-articular fractures of distal radius between January 2015 and December 2017 were retrospectively analyzed. According to the different methods of intraoperative assisted treatment, the patients were divided into the trial group (11 cases with carpal arthroscopy assisted treatment) and the control group (39 cases with traditional open reduction). There was no significant difference between the two groups in general data such as gender, age, affected side, cause of injury, time from injury to operation, and preoperative displacement ( >0.05), which were comparable. Six patients in the trial group had triangular fibrocartilage complex (TFCC) injury and received one-stage repair. Postoperative X-ray films were taken to estimate the fracture reduction. Patient-Rated Wrist Evaluation (PRWE) wrist function score and modified Mayo score were used at 3 months after operation to evaluate the function of the wrist. The range of wrist flexion, extension, pronation, and supination motion of the two groups were recorded and compared at 3 months after operation. Patients in the trial group were further divided into the reduction group after arthroscopic exploration (group A, 6 cases) and the simple cleaning group after arthroscopic exploration (group B, 5 cases), and their wrist motions were compared.
The operation time of the trial group was greater than that of the control group ( =11.08, =0.00). There was no significant difference in intraoperative blood loss and fracture reduction between the two group ( >0.05). X-ray film at 1 day after operation showed that the degree of fracture displacement was significantly decreased when compared with preoperative one in each group ( <0.05), but no significant difference was found between the two groups at 1 day after operation ( =0.19, =0.85). Patients in both groups were followed up 8-20 months, with an average of 12 months. There was no significant difference in fracture healing time between the two groups ( =0.52, =0.60). At 3 months after operation, the PRWE score, modified Mayo score, and wrist motions in the trial group were all better than those in the control group ( <0.05). There was no significant difference in wrist motions between group A and group B ( >0.05).
Carpal arthroscope assisted treatment of intra-articular fractures of distal radius can achieve good reduction and postoperative function. Meanwhile, TFCC, ligament, articular cartilage, and other injuries can be repaired in one stage.
探讨腕关节镜治疗桡骨远端关节内骨折的早期疗效。
回顾性分析2015年1月至2017年12月收治的50例桡骨远端关节内骨折患者的临床资料。根据术中辅助治疗方法的不同，将患者分为试验组（11例行腕关节镜辅助治疗）和对照组（39例行传统切开复位）。两组患者在性别、年龄、患侧、受伤原因、受伤至手术时间、术前移位等一般资料方面比较，差异无统计学意义（P>0.05），具有可比性。试验组6例合并三角纤维软骨复合体（TFCC）损伤，均一期修复。术后摄X线片评估骨折复位情况。术后3个月采用患者自评腕关节评价（PRWE）腕关节功能评分及改良Mayo评分评估腕关节功能。记录并比较两组术后3个月腕关节的屈伸、旋前、旋后活动度。试验组患者进一步分为关节镜探查后复位组（A组，6例）和关节镜探查后单纯清理组（B组，5例），比较两组腕关节活动度。
试验组手术时间长于对照组（t=11.08，P=0.00）。两组术中出血量及骨折复位情况比较，差异无统计学意义（P>0.05）。术后1天X线片显示，两组骨折移位程度较术前均明显减小（P<0.05），但术后1天两组间比较差异无统计学意义（t=0.19，P=0.85）。两组患者均随访8～20个月，平均12个月。两组骨折愈合时间比较，差异无统计学意义（t=0.52，P=0.60）。术后3个月，试验组PRWE评分、改良Mayo评分及腕关节活动度均优于对照组（P<0.05）。A组与B组腕关节活动度比较，差异无统计学意义（P>0.05）。
腕关节镜辅助治疗桡骨远端关节内骨折能获得良好的复位及术后功能。同时可一期修复TFCC、韧带、关节软骨等损伤。
