掌侧与背侧手术入路治疗成人桡骨近端骨折:一项前瞻性随机对照试验

Nishchal Rijal, B. Shrestha, Rosan Ps Kalawar, B. Pokharel, P. Baral
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引用次数: 0

摘要

背景:切开复位钢板螺钉内固定是成人前臂双骨骨折的标准治疗方法。对于桡骨近端三分之一或一半的骨折,均采用掌侧(Henry)入路和背侧(Thompson)入路,每种入路各有优缺点。目的:研究的目的是比较两种入路的功能结局、术中参数、并发症和联合时间。方法:随机对照试验于2017年10月至2018年9月在达兰b.p.柯伊拉腊健康科学研究所(BPKIHS)骨科进行,为期12个月。50例桡骨近端骨折患者随机分为两组:A组和B组。A组(n=25)患者经掌侧入路手术,B组(n=25)经背侧入路手术。分别于术后第2天、第2周、第6周、第12周和第24周对患者的功能结局、骨折愈合的临床和放射学征象及并发症进行评估。结果:两组术中参数(切口长度、手术时间、止血带时间)比较,差异无统计学意义(p值> 0.05)。在患者随访期间,两组患者的活动范围(ROM)渐进式增加,手臂、肩膀和手的残疾(DASH)评分渐进式下降,表明两组患者的功能结局均有所改善(p值> 0.05)。术后出现3例后骨间神经麻痹(掌侧组1例,背侧组2例),掌侧组深部手术部位感染1例,背侧组骨不连1例。结论:两种手术入路在功能结局、术中参数、并发症及愈合时间方面具有可比性。虽然两组均有PIN麻痹病例,但发生率差异无统计学意义。由于两种入路并发症发生率均较低,可根据术者的喜好选择。然而,对于成人桡骨近端骨折手术入路的选择,有必要进行大规模的多中心研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Volar versus dorsal surgical approaches in fractures of proximal radius in adults: A prospective randomized controlled trial
Background: Open reduction and internal fixation with plates and screws is the standard treatment for both-bone forearm fractures in adults. For fractures of the proximal one-third or half of the radius, both the volar (Henry) and dorsal (Thompson) approaches are employed and each one has its own advantages and disadvantages. Objectives: The aim of the study was to compare the functional outcome, intraoperative parameters, complications and duration of union between the two approaches. Methodology: The randomized controlled trial was conducted in the Department of Orthopaedics, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, over a period of 12 months (October 2017 to September 2018). Fifty patients with proximal radius fractures were randomized into two groups: Group A and Group B. Patients in Group A (n=25) underwent surgery via the volar approach whereas those in Group B (n=25) via the dorsal approach. They were evaluated on the second postoperative day and at 2, 6, 12 and 24 weeks postoperatively with regards to functional outcome, clinical and radiologic signs of fracture union and complications. Results: The difference in the intraoperative parameters (length of incision, duration of surgery, tourniquet time) was not statistically significant between the two groups (p-values > 0.05). There was a progressive increase in range of motion (ROM) and a progressive decrease in the Disabilities of the Arm, Shoulder and Hand (DASH) scores, signifying improving functional outcome in both the groups during patient follow-up (p-values > 0.05). Three cases of posterior interosseous nerve (PIN) palsies (one in the volar group and two in the dorsal group), one case of deep surgical site infection in the volar group and one case of nonunion in the dorsal group were encountered. Conclusion: The surgical approaches were comparable in terms of functional outcome, intraoperative parameters, complications and time to union. Though cases with PIN palsy were seen in both the groups, the difference in the occurrences was not statistically significant. As both the approaches were associated with a low rate of complications, either can be used based on the preference of the operating surgeon. However, large scale multicenter studies are necessary to recommend guidelines on the choice of surgical approach for proximal radius fractures in adults.
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