橈骨遠位端関節内粉砕型骨折に対する方形回内筋温存掌側ロッキングプレート固定術後における早期リハビリテーションの有用性

Positive effects of early postoperative rehabilitation after volar locking plate fixation with a pronator quadrates sparing approach for intraarticular distal radius comminuted fractures

要旨：当院整形外科では橈骨遠位端粉砕骨折に対し掌側ロッキングプレート固定の侵入法を方形回内筋（以下，PQ）切離から温存へ変更した．PQ切離群は回外運動を術後2週間禁止したが，PQ温存群は術後翌日からすべての可動域訓練を開始した．術後1，2，3ヵ月で握力と手関節背屈／掌屈，前腕回内／回外自動運動角度の測定と，QuickDASH値，VAS値を算定した．術後2ヵ月でPQ温存群の回内角度が有意に大きく，VAS値は有意に小さくなった．QuickDASH値は術後1，2ヵ月でPQ温存群が有意に小さかった．PQを温存し術後早期から制限なく可動域訓練を行うことは関節痛の軽減や上肢ADL向上に好影響し，低下したPQの機能回復を促進することが示唆された．

　The surgical approach in volar locking plate fixation for intraarticular distal radius fractures has been changed from a pronator quadrates (PQ) muscle cutting to a sparing approach. In the PQ-cutting group, supination was inhibited by splinting for 2 weeks after operation. However, range of motion exercises were started with no limitation from the next day after operation in the PQ-sparing group. The mean value of pronation was significantly larger and VAS score significantly smaller in the PQ-sparing group at 2 months post-op compared with the PQ-cutting group. Furthermore, the mean QuickDASH score in the PQ-sparing group was significantly smaller than the PQ-cutting group after 1 and 2 months. It is suggested that the PQ muscle sparing approach is safe and effective in VLP fixation of the distal radius.