摘要
目的:比较不同入路锁定加压钢板(LCP)内固定术治疗FernandezⅢ、Ⅳ型桡骨远端骨折对患者术后恢复效果及白介素-(IL-6)、白介素-1β(IL-1β)的影响。方法:用随机数字表法将莆田市第一医院骨科于2019年8月-2020年9月收治的70例FernandezⅢ、Ⅳ型桡骨远端骨折患者分为观察组和对照组,每组35例。对照组采取直接掌侧入路LCP固定术治疗,观察组采取掌侧微创入路LCP固定术治疗。比较两组围手术期指标、术后恢复及并发症发生情况,同时比较手术前后两组患者炎症反应,腕关节活动情况,上肢损伤、疼痛及腕关节功能恢复情况。结果:两组手术时间比较,差异无统计学意义(P>0.05);观察组切口长度明显小于对照组、术中出血量明显少于对照组,血液循环恢复良好时间、住院时间、骨折愈合时间均明显短于对照组,差异均有统计学意义(P<0.05);观察组术后3个月的IL-6、IL-1β、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均明显低于对照组,差异均有统计学意义(P<0.05);观察组术后3个月的背伸、掌屈、旋前、旋后腕关节活动度均明显高于对照组,差异均有统计学意义(P<0.05);观察组术后3个月的上肢功能评定表(DASH)、视觉模拟评分法(VAS)、Gartland-wreley腕关节评分系统(GW)评分均明显低于对照组,差异均有统计学意义(P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:与直接掌侧入路LCP固定术相比,掌侧微创入路LCP固定术能有效加快FernandezⅢ、Ⅳ型桡骨远端骨折患者骨折愈合速度,减轻患者机体炎症反应,促进腕关节功能恢复,且不增加并发症,具有一定安全性。
Objective:To compare the effects of different approaches of locking compression plate(LCP)internal fixation in the treatment of FernandezⅢandⅣdistal radius fractures on postoperative recovery,and the effects on interleukin-6(IL-6)and interleukin-1β(IL-1β).Method:A total of 70 patients with FernandezⅢandⅣdistal radius fractures admitted to the Department of Orthopedics,The First Hospital of Putian from August 2019 to September 2020 were divided into observation group and control group by random number table method,with 35 patients in each group.The control group was treated with LCP fixation via direct volar approach,and the observation group was treated with LCP fixation via minimally invasive volar approach.The perioperative indicators,postoperative recovery and incidence of complications were compared in the two groups.Meanwhile,the inflammatory response,wrist joint movement,upper limb injury,pain,and wrist function recovery of the two groups before and after the operation were compared.Result:There was no significant difference in operation time between the two groups(P>0.05).The incision length of the observation group was significantly smaller than that of the control group,and the intraoperative blood loss was significantly less than that of the control group,the blood circulation recovery time,hospital stay and fracture healing time of the observation group were significantly shorter than those of the control group,the differences were statistically significant(P<0.05).The levels of IL-6,IL-1β,C reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in the observation group at 3 months after operation were significantly lower than those in the control group,the differences were statistically significant(P<0.05).The ranges of wrist dorsal extension,palmar flexion,pronation and supination in the observation group at 3 months after operation were significantly greater than those in the control group,the differences were statistically significant(P<0.05).The disability of arm,shoulder and hand(DASH)scores,visual analogue scale(VAS)scores and Gartland-wreley wrist joint scoring system(GW)scores of the observation group at 3 months after operation were significantly lower than those of the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:Compared with LCP fixation via direct volar approach,LCP fixation via minimally invasive volar approach can effectively accelerate fracture healing of patients with FernandezⅢandⅣdistal radius fractures,alleviate inflammatory of the patient’s body,promote wrist joint function recovery,with no increase in complications,and has a certain safety.
作者
阮原芳
林敏
翁荔芳
王新标
何振森
郭佳勇
RUAN Yuanfang;LIN Min;WENG Lifang;WANG Xinbiao;HE Zhensen;GUO Jiayong(The First Hospital of Putian,Fujian Province,Putian 351100,China;不详)
出处
《中国医学创新》
CAS
2022年第34期134-139,共6页
Medical Innovation of China
