桡骨开口截骨植骨术与闭口式截骨术对桡骨远端畸形愈合的疗效及腕关节功能评价

目的探讨桡骨开口截骨植骨术与闭口式截骨术对桡骨远端畸形愈合的疗效及腕关节功能的影响。方法回顾性分析2008年7月～2014年5月湖北医药学院附属东风医院收治的46例桡骨远端畸形愈合的临床资料,按照实施手术方法分为开口组25例和闭口组21例,开口组行开口式桡骨远端截骨术,闭口组行闭口式桡骨截骨术,记录两组患者手术时间、截骨愈合时间及并发症发生情况;分别于手术前、术后测量两组患者掌倾角、尺偏角及尺骨变异程度,并采用Mayo腕关节评分法评价患者腕关节功能。结果开口组和闭口组患者手术时间(129.4±13.2)min vs.(135.2±14.8)min]、截骨愈合时间(2.1±0.4)个月vs.(2.2±0.6)个月]比较差异无统计学意义(P0.05),开口组并发症发生率16.0%(4/25),闭合组为14.3%(3/21),两组并发症发生率比较差异亦无统计学意义(P0.05)。术后两组掌倾角显著降低,尺偏角显著增加,尺骨变异显著缩短,与术前比较差异具有统计学意义(P0.05);两组间比较,术后闭口组尺偏角显著小于开口组(19.3±2.5)°vs.(24.6±3.7)°],尺骨变异显著低于开口组(0.4±0.1)mm vs.(2.8±0.4)mm,P0.05]。术后两组患者屈伸活动、旋转活动均显著提高,与手术前比较差异具有统计学意义(P0.05);闭口组屈伸活动度显著大于开口组(143.8±17.6)°vs.(114.3±14.7)°,P0.05],两组旋转活动度比较差异无统计学意义(157.4±17.1)°vs.(153.7±16.5)°,P0.05]。闭口组优良率为95.2%,开口组优良率为72.0%,闭口组腕关节优良率显著高于开口组(P0.05)。结论闭口式截骨术在改善桡骨远端畸形愈合患者尺骨变异、腕关节活动度及腕关节功能方面显著优于开口式矫形截骨术,值得临床推广。

Clinical efficacy and wrist joint function evaluation of radial opening osteotomy with bone grafting and closed osteotomy in treating distal radial malunion

Objective To explore the clinical efficacy and wrist joint function of radial opening osteotomy with bone grafting and closed osteotomy in treating patients with distal radial malunion. Methods Clinical data of 46 cases of distal radial malunion were retrospectively analyzed, who were treated in Dongfeng Hospital of Hubei University of Medicine from Jul.2008 to May 2014.Patients were divided into open group (25 cases) and closed group (21 cases) according to the operation method.The open group underwent open distal radius osteotomy with bone grafting;and the closed group was given closed osteotomy.The operation time,the healing time and the complication of the two groups were recorded.Palmar tilt,ulnar deviation and ulnar variance degree of two groups before and after surgery were measured, and Mayo wrist score was used to evaluate the patients' wrist joint function. Results The operation time(129.4±13.2)min vs.(135.2±14.8)min] and bone healing time(2.1±0.4) month vs.(2.2±0.6)months] of the open group and the closed group had no significant difference (P>0.05).The complication rate of the open group was 16.0% (4/25),and was 14.3% (3/21) in the closed group,without statistically significant difference between the two groups(P>0.05).The postoperative palmar tilt was significantly reduced,the ulnar deviation was increased,and the ulnar variance was significantly shortened,with statistical differences in comparison with before operation (P<0.05).The ulnar deviation of the closed group was significantly less than that of the open group (19.3±2.5)° vs.(24.6±3.7)°],ulnar variance was significantly lower than that of the open group(0.4±0.1)mm vs.(2.8±0.4)mm, P<0.05].The flexion and extension activities,and the rotational activities of the two groups were significantly improved compared with before surgery (P<0.05).The flexion and extension activity of the closed group was significantly higher than that of the open group (143.8±17.6)°vs.(114.3±14.7)°, P<0.05], and the rotating activity of the two groups had no statistically significant difference (157.4±17.1)°vs.(153.7±16.5)°(P>0.05).The excellent and good rate of the open group was 95.2% and was 72.0% in the closed group,and there was no statistically significant difference between the two groups(P>0.05). Conclusion Closed osteotomy can improve distal radial malunion,which is better in ulnar variance,wrist joint activity degree and wrist joint function than the opening osteotomy,and it is worthy of clinical promotion.