Feasibility and efficacy observation of minimally invasive approach for the treatment of intra-articular fractures of the distal radius with 1 cm small incision with preservation of pronator quadratus under wrist arthroscopy
Objective To observe the feasibility and clinical efficacy of minimally invasive approach for the treatment of intra-articular fractures of the distal radius with 1 cm small incision with preservation of pronator quadratus under wrist arthroscopy.Methods From September 2021 to February 2023,63 patients with intra-articular fractures of the distal radiuswere treated in our department.28 patients underwent minimally invasive surgery using a 1 cm small incision preserving pronator quadratus,with the assistance of wrist arthroscopy during the surgery.35 cases underwent traditional Henry approach surgery.The perioperative indicators and follow-up data between two groups of patients were compared.Results All 63 patients underwent surgery smoothly.There was no statistically significant difference in general information,length of hospital stay,and wound healing level between the two groups of patients(P＞0.05).The surgical time in the minimally invasive group was(90.0±7.2)minutes,which was an increase compared to the traditional group(55.0±5.7)minutes(P＜0.05).The postoperative follow-up was 6 to 13 months,with an average of 8.3 months.No postoperative complications such as wound infection,vascular or nerve damage were found in both groups of patients.Over time,the VAS and wrist joint range of motion of all included patients gradually improved.At 3 days and 1 week after surgery,the VAS in the minimally invasive group was significantly lower than that in the traditional group[(3.8±2.2)vs(6.6±2.3),P=0.026;(3.2±1.4)vs(5.7±2.8),P=0.041].There was no significant difference between the two groups at 1,3,and 6 months after surgery(P＞0.05).At one week after surgery,the minimally invasive group had significantly better flexion,extension,and rotational mobility than the traditional group[(90.0±13.8)° vs(81.0±7.6)°,P=0.017;(79.6±9.2)° vs(61.1±15.6)°,P＜0.001].At 3 months after surgery,the Mayo wrist joint function score showed a statistically significant improvement rate of 25/3(89.2％)in the minimally invasive group and 29/6(82.85％)in the traditional group.The difference was statistically significant(P=0.039).Conclusion The minimally invasive approach with 1 cm small incision with preservation of pronator quadratus for the treatment of intra-articular fractures of the distal radius has good operability and reliability,as well as advantages such as minimal trauma,quick recovery,short pain period,and improved postoperative joint function.It is worthy of clinical promotion and application.
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