Ruch David S, Papadonikolakis Anastasios
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
J Hand Surg Am. 2006 Jan;31(1):9-16. doi: 10.1016/j.jhsa.2005.09.011.
To compare the complications and functional and radiographic outcomes of volar and dorsal plating of intra-articular distal radius fractures.
This retrospective review included 34 patients found by searching a database of 350 patients treated for distal radius fractures. Inclusion criteria were (1) at least 1 year of follow-up data and (2) open reduction and internal fixation of a multifragmentary fragment intra-articular distal radius fracture with either a nonlocking volar or dorsal plate. Twenty patients were treated with a dorsal plate and 14 patients were treated with a volar nonlocking plate. Objective and subjective outcome parameters were compared between the 2 groups. Objective evaluations included wrist range of motion, grip strength, and preoperative and postoperative radiographic parameters (radial inclination, palmar tilt, ulnar variance, fracture pattern). Subjective evaluations were performed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score and the Gartland and Werley score.
Volar plating resulted in a significantly better Gartland-Werley score compared with dorsal plating. There were no significant differences in the DASH score. Volar collapse was documented in 5 of the 20 patients in the dorsal plating group, which resulted in a mild loss of pronation compared with the volar plating group. No collapse occurred in the volar plating group. In addition the difference in the percentage of wrist range of motion compared with the contralateral wrist was not significant. Dorsal plating was associated with a ruptured extensor indicis tendon in 1 patient; secondary surgical procedures were required in 4 patients (tenolyses and radial styloidectomy). Volar plating was associated with median nerve neuropathy in 2 patients and intersection syndrome in one.
Although both groups of patients had similar DASH scores the functional outcome in terms of Gartland and Werley scores was better in the volar plating group. In addition there was a higher rate of volar collapse and late complications in the dorsal plating group compared with the volar plating group.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.
比较桡骨远端关节内骨折掌侧钢板固定与背侧钢板固定的并发症、功能及影像学结果。
本回顾性研究纳入了通过检索350例桡骨远端骨折患者数据库筛选出的34例患者。纳入标准为：（1）至少1年的随访数据；（2）采用非锁定掌侧或背侧钢板对桡骨远端关节内多块骨折进行切开复位内固定。20例患者采用背侧钢板治疗，14例患者采用掌侧非锁定钢板治疗。比较两组的客观和主观结果参数。客观评估包括腕关节活动范围、握力以及术前和术后的影像学参数（桡骨倾斜度、掌倾角、尺骨变异、骨折类型）。主观评估采用上肢、肩部和手部功能障碍（DASH）问卷评分及Gartland和Werley评分。
与背侧钢板固定相比，掌侧钢板固定的Gartland-Werley评分明显更好。DASH评分无显著差异。背侧钢板固定组20例患者中有5例出现掌侧塌陷，与掌侧钢板固定组相比，旋前功能轻度丧失。掌侧钢板固定组未发生塌陷。此外，与对侧腕关节相比，腕关节活动范围百分比的差异不显著。背侧钢板固定有1例患者发生示指伸肌腱断裂；4例患者需要二次手术（肌腱松解术和桡骨茎突切除术）。掌侧钢板固定有2例患者发生正中神经病变，1例发生交叉综合征。
虽然两组患者的DASH评分相似，但掌侧钢板固定组在Gartland和Werley评分方面的功能结果更好。此外，与掌侧钢板固定组相比，背侧钢板固定组掌侧塌陷和晚期并发症的发生率更高。
研究类型/证据水平：治疗性研究，Ⅲ级。
