[1]刘子祯陈光鑫汤斌栾兆新李正勋.腕关节镜辅助下闭合复位支架外固定与切开复位钢板内固定治疗桡骨远端关节内粉碎性骨折的疗效比较[J].中国微创外科杂志,2025,01(9):550-556.
　Liu Zizhen,Chen Guangxin,Tang Bin,et al.Comparison of Wrist Arthroscopy Assisted Closed Reduction With External Fixation and Open Reduction With Steel Plate Internal Fixation for Intraarticular Comminuted Fractures of the Distal Radius[J].Chinese Journal of Minimally Invasive Surgery,2025,01(9):550-556.
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腕关节镜辅助下闭合复位支架外固定与切开复位钢板内固定治疗桡骨远端关节内粉碎性骨折的疗效比较()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年9期
页码:
550-556
栏目:
临床研究
出版日期:
2025-09-25

文章信息/Info

Title:
Comparison of Wrist Arthroscopy Assisted Closed Reduction With External Fixation and Open Reduction With Steel Plate Internal Fixation for Intraarticular Comminuted Fractures of the Distal Radius
作者:
刘子祯陈光鑫汤斌栾兆新李正勋
(聊城市第二人民医院手足显微外科，聊城252000)
Author(s):
Liu Zizhen;  Chen Guangxin;  Tang Bin;  et al.
Department of Hand and Foot Microsurgery, Liaocheng Second People’s Hospital, Liaocheng 252000, China
关键词:
腕关节镜; 闭合复位; 支架外固定; 桡骨粉碎性骨折
Keywords:
Wrist arthroscopy; Closed reduction; External fixation with bracket; Comminuted fractures of the radius
文献标志码:
A
摘要:
目的探讨腕关节镜辅助下闭合复位支架外固定治疗桡骨远端关节内粉碎性骨折(C3型)的临床疗效。方法回顾性分析我院2022年3月～2023年2月98例桡骨远端关节内粉碎性骨折的临床资料，其中48例腕关节镜辅助下闭合复位联合支架外固定手术为关节镜组，50例切开复位钢板内固定手术为传统切开组。比较2组手术时间、术中出血量、切口长度、骨折愈合时间、关节活动度、视觉模拟评分（Visual Analogue Scale,VAS)和GartlandWerley腕关节功能评分，采用掌倾角、尺偏角和桡骨高度影像学指标，评估不同时间节点影像学指标。结果关节镜组手术时间(55.3±10.5)min,显著短于传统切开组(83.4±14.6)min(t=-10.979，P=0.000)；术中出血量(42.3±8.6)ml,显著少于传统切开组(71.4±10.5)ml(t=-14.953，P=0.000)；切口长度(1.3±0.3)cm，显著短于传统切开组(5.1±1.5)cm(t=-18.550，P=0.000)；骨折愈合时间(10.7±1.4)周，显著短于传统切开组(12.2±1.6)周(t=-4.855，P=0.000)。术后6个月关节镜组掌屈活动度68.8°±8.3°，显著高于传统切开组61.5°±9.4°(t=4.002，P=0.000)；背伸活动度63.9°±7.5°，显著高于传统切开组59.2°±8.3°(t=2.931，P=0.004)；旋前活动度674°±10.3°，显著高于传统切开组62.1°±9.9°(t=2.604，P=0.011)；旋后活动度70.5°±74°，显著高于传统切开组64.4°±86°(t=3.777，P=0.000)。关节镜组VAS评分(1.3±0.6)分，显著低于传统切开组(1.7±0.5)分(t=-3.941，P=0.000)。术后6个月关节镜组GartlandWerley腕关节功能评分优良率显著高于传统切开组(Z=-2.614,P=0.009)。关节镜组腕关节影像学指标桡骨高度、掌倾角、尺偏角显著高于传统切开组(均P=0.000)；组内不同时点两两比较掌倾角、尺偏角差异无显著性(P>0.05)，桡骨高度除术后3 d、1个月与术后6个月差异有显著性（P=0015,P=0.035）外,其余时点两两比较差异无显著性（P>0.05）；掌倾角、尺偏角和桡骨高度时间×组别交互作用不显著(P>0.05)。结论腕关节镜辅助下闭合复位支架外固定手术治疗桡骨远端关节内粉碎性骨折，具有手术时间短、术中出血量少、腕关节功能恢复好等优点。
Abstract:
ObjectiveTo explore the clinical efficacy of wrist arthroscopy assisted closed reduction with external fixation in the treatment of intraarticular comminuted fractures of the distal radius(type C3).MethodsA retrospective analysis was conducted on 98 patients with type C3 intraarticular comminuted fractures of the distal radius admitted to our hospital from March 2022 to February 2023. Among them, 48 patients underwent wrist arthroscopy assisted closed reduction with external fixation with a bracket (arthroscopy group), and another 50 patients underwent open reduction with steel plate internal fixation surgery (control group). The two groups were compared in terms of operation time, intraoperative bleeding volume, incision length, fracture union time, range of motion(ROM) of joint, Visual Analogue Scale (VAS), and GartlandWerley wrist scores, as well as radiographic parameters (palmar tilt, ulnar inclination, and radial height) evaluated at various followup intervals.ResultsThe arthroscopy group had an operation time of (55.3±10.5) min, which was significantly shorter than that in the control group ［(83.4±14.6) min; t=-10.979, P=0000］. The intraoperative bleeding volume in the arthroscopy group was (42.3±8.6) ml, which was less than that in the control group ［(71.4±10.5) ml; t=-14.953, P=0.000］. The incision length of the arthroscopy group was (1.3±0.3) cm, which was shorter than that of the control group ［(5.1±1.5) cm; t=-18.550, P=0.000］. The arthroscopy group had a fracture healing time of (10.7±1.4) weeks, which was shorter than that in the control group ［(12.2±1.6) weeks; t=-4.855, P=0.000］. The palmar flexion ROM in the arthroscopy group was 68.8°±8.3°, which was significantly higher than that in the control group (61.5°±9.4°; t=4.002, P=0000). The dorsiflexion ROM in the arthroscopy group was 63.9°±7.5°, which was significantly higher than that in the comtrol group (59.2°±8.3°; t=2.931, P=0.004). The pronation ROM in the arthroscopy group was 67.4°±10.3°, which was significantly higher than that in the control group (621°±99°; t=2.604, P=0.011). The supination ROM in the arthroscopy group was 70.5°±7.4°, which was significantly higher than that in the control group (64.4°±8.6°; t=3.777, P=0000). The VAS score of the arthroscopy group was (1.3±0.6) points, which was significantly lower than that in the control group ［(1.7±0.5) points; t=-3.941, P=0.000］. After 6 months, the GartlandWerley wrist scores of the arthroscopy group was significantly higher than that of the control group (Z=-2.614, P=0.009). The wrist joint imaging showed significantly higher radial height, palmar inclination angle, and ulnar deviation angle in the arthroscopy group than the control group (all P=0.000), while there were no significant differences in palmar inclination angle and ulnar deviation angle at different time points within each group (P>0.05). Except for significant differences in radial height at 3 d, 1 month, and 6 months after surgery (P=0.015, P=0.035), there were no significant differences between any other time points (P>0.05). The interaction between time and group was not significant for palm inclination angle, ulnar deviation angle, and radial height (P>0.05).ConclusionWrist arthroscopy assisted closed reduction with external fixation for intraarticular comminuted fractures of distal radius has advantages of short operation time, less intraoperative blood loss, and good recovery of wrist joint functions.

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备注/Memo

备注/Memo:
通讯作者，Email：lizhengxun750512@126.com①（山东大学第二医院手外科/足踝外科，济南250000）①
更新日期/Last Update: 2025-10-17