Evaluation of different surgical methods for traumatic distal radius fractures based on wrist function, elbow function and imaging parameters
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摘要:
目的 探讨基于腕关节功能、肘关节功能和影像学参数探讨不同术式治疗创伤性桡骨远端骨折的疗效。 方法 选择2015年1月~2022年1月我科收治的80例创伤性桡骨远端骨折患者作为研究对象，所有患者均因间接暴力受伤，为单侧闭合性骨折，根据骨折分型和程度，按不同术式将患者分为两组，其中A组38例采用背侧入路切开复位钢板内固定术；B组42例采用掌侧入路切开复位钢板内固定术，对比分析两组患者的腕关节功能评分、肘关节功能评分，采用我院医学影像信息处理系统测量并记录两组术后骨折端复位情况相关的影像学参数（桡骨远端高度、掌倾角、尺偏角），采用Logistic回归模型分析创伤性桡骨远端骨折固定术后关节功能恢复不良的影响因素。 结果 两组术后疼痛、功能、活动度评分均高于术前（P < 0.05），且B组术后上述腕关节功能评分均高于A组（P < 0.05）；两组术后关节活动范围、疼痛、稳定性、功能评分均高于术前（P < 0.05），且B组术后上述肘关节功能评分均高于对照组（P < 0.05）；两组术后桡骨远端高度、掌倾角、尺偏角均高于术前（P < 0.05），且研究组术后掌倾角高于对照组（P < 0.05）；本研究共80例患者，根据术后腕关节功能评分和肘关节功能评分结合影像学复查，术后恢复良好58例，恢复不良22例，单因素分析结果显示，年龄、末次复查掌倾角、手术方式与创伤性桡骨远端骨折固定术后关节功能恢复不良有关（P < 0.05），性别、骨折分型与创伤性桡骨远端骨折固定术后关节功能恢复不良无关（P>0.05）；Logistic回归分析结果显示年龄、末次复查掌倾角、手术方式均是创伤性桡骨远端骨折固定术后关节功能恢复不良的独立影响因素（P < 0.05）。 结论 通过掌侧入路切开复位钢板内固定术治疗创伤性桡骨远端骨折的疗效更佳，促进腕关节功能和肘关节功能恢复，改善与术后骨折端复位情况有关的影像学参数，可有效改善患者的预后。 Abstract:Objective To explore the effect of different surgical methods on traumatic distal radius fracture based on wrist function, elbow function and imaging parameters. Methods We selected 80 patients with traumatic distal radius fractures who were treated in our department from January 2015 to January 2022. All patients were injured by indirect violence and were unilateral closed fractures. According to the type and degree of fractures, the patients were divided into two groups according to different surgical methods. Among them, 38 patients in group A were treated by open reduction and internal fixation with steel plates through the dorsal approach; 42 patients in group B were treated with open reduction and internal fixation with steel plate through the volar approach. The wrist joint function scores and elbow joint function scores of the two groups were compared. The imaging parameters (distal radius height, palmar inclination angle, ulnar deflection angle) related to the reduction of the fracture end in the two groups were measured and recorded with the medical image information processing system of our hospital. Logistic regression model was used to analyze the influencing factors of poor joint function recovery after traumatic distal radius fracture fixation. Results The scores of pain, function and activity in both groups were higher than those before operation (P < 0.05), and the scores of wrist function in group B were higher than those in group A (P < 0.05). The scores of range of motion, pain, stability and function of joints in both groups were higher than those before operation (P < 0.05), and those of elbow joints in group B were higher than those in the control group (P < 0.05). The height of distal radius, palmar obliquity and ulnar declination angle in both groups were higher than those before operation (P < 0.05), and the palmar obliquity in the study group was higher than that in the control group (P < 0.05). According to the wrist joint function score and elbow joint function score combined with imaging review, 58 patients recovered well and 22 patients did not. The univariate analysis showed that age, the last review palm angle and the mode of operation were related to the poor recovery of joint function after the fixation of traumatic distal radius fracture (P < 0.05), while the gender and fracture type were not related to the poor recovery of joint function after the fixation of traumatic distal radius fracture (P>0.05). The Logistic regression analysis showed that age, the last review palm angle, and the mode of operation were all independent influencing factors for poor recovery of joint function after fixation of traumatic distal radius fracture (P < 0.05). Conclusion The treatment of traumatic distal radius fracture by volar approach open reduction and internal fixation with steel plate is more effective. It can promote the recovery of wrist joint function and elbow joint function, improve the imaging parameters related to the reduction of the fracture end after surgery, and effectively improve the prognosis of patients. -
表 1 两组患者的一般资料比较
Table 1. Comparison of general data of the patients in two groups.
组别 男/女（n） 年龄（岁, Mean±SD） 骨折分型（n） 致伤原因（n） 受伤侧别（n） AO-B型 AO-C型 摔伤 交通伤 左侧 右侧 A组（n=38） 14/24 60.22±9.17 15 23 31 7 13 25 B组（n=42） 18/24 60.19±9.22 14 28 35 7 15 27 t/χ2 0.300 0.015 0.325 0.040 0.020 P 0.583 0.990 0.568 0.837 0.888 A组: 背侧入路切开复位钢板内固定术组; B组: 掌侧入路切开复位钢板内固定术组. 
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表 2 两组术前术后的腕关节功能评分比较
Table 2. Comparison of wrist joint function scores between the two groups before and after operation (score, Mean±SD)
组别 疼痛 功能 活动度 术前 术后 术前 术后 术前 术后 A组（n=38） 25.39±0.18 30.26±0.16* 25.17±0.22 28.22±0.23* 20.17±1.22 23.26±1.02* B组（n=42） 25.38±0.19 33.36±0.22* 25.16±0.19 30.36±0.17* 20.18±1.23 25.69±1.27* t 0.241 71.421 0.218 47.623 0.036 9.372 P 0.810 < 0.001 0.830 < 0.001 0.970 < 0.001 *P < 0.05 vs术前.
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表 3 两组术前术后的肘关节功能评分比较
Table 3. Comparison of elbow joint function scores between the two groups before and after operation (score, Mean±SD)
组别 关节活动范围 疼痛 稳定性 功能 术前 术后 术前 术后 术前 术后 术前 术后 A组（n=38） 15.36±0.16 17.22±0.22* 38.24±0.16 40.22±0.26* 6.24±0.16 8.53±0.22* 20.17±0.16 22.49±0.25* B组（n=42） 15.38±0.18 19.36±0.16* 39.15±0.19 43.26±0.24* 6.25±0.24 10.68±0.16* 20.19±0.17 24.38±0.27* t 0.523 50.089 0.253 54.381 0.217 50.323 0.540 32.381 P 0.600 < 0.001 0.800 < 0.001 0.830 < 0.001 0.590 < 0.001 *P < 0.05 vs术前.
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表 4 两组术后骨折端复位情况比较
Table 4. Comparison of fracture end reduction between two groups (Mean±SD)
组别 桡骨远端高度（mm） 掌倾角（°） 尺偏角（°） 术前 术后 术前 术后 术前 术后 A组（n=38） 6.28±0.22 10.36±0.24* 4.22±3.12 6.23±0.27* 16.24±4.05 18.22±5.12* B组（n=42） 6.29±0.17 10.37±0.17* 4.23±3.09 8.06±2.12* 16.25±4.12 18.23±5.09* t 0.229 0.217 0.014 5.279 0.011 0.009 P 0.820 0.830 0.990 < 0.001 0.990 0.990 *P < 0.05 vs术前.
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表 5 创伤性桡骨远端骨折固定术后关节功能恢复不良的单因素分析
Table 5. Single factor analysis of poor joint function recovery after fixation of traumatic distal radius fracture
因素 恢复良好（n=58） 恢复不良（n=22） χ2 P 性别 2.680 0.102 男（n=32） 20（34.48） 12（54.55） 女（n=48） 38（65.52） 10（45.45） 年龄 5.290 0.021 < 60岁（n49） 40（68.97） 9（40.91） ≥60岁（n=31） 18（31.03） 13（59.09） 骨折分型 0.258 0.612 AO-B（n=29） 22（37.93） 7（31.82） AO-C（n=51） 36（62.07） 15（68.18） 末次复查掌倾角（°） 10.110 0.002 ≥6（n=60） 38（65.52） 22（100.00） < 6（n=20） 20（34.48） 0（0.00） 手术方式 14.330 < 0.001 背侧入路切开复位内固定术（n=38） 20（34.48） 18（81.82） 掌侧入路切开复位内固定术（n=42） 38（65.52） 4（18.18）
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表 6 创伤性桡骨远端骨折固定术后关节功能恢复不良的多因素Logistic回归分析
Table 6. Multivariate logistic regression analysis of poor joint function recovery after fixation of traumatic distal radius fracture
因素 B S.E χ2 P OR 95% CI 年龄 1.168 0.223 27.433 < 0.001 3.216 2.077~4.978 末次复查掌倾角 1.026 0.335 9.380 0.002 2.790 1.447~5.380 手术方式 2.006 1.003 4.000 0.046 7.434 1.041~53.084
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