Goldfarb Charles A, Rudzki Jonas R, Catalano Louis W, Hughes Michael, Borrelli Joseph
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
J Hand Surg Am. 2006 Apr;31(4):633-9. doi: 10.1016/j.jhsa.2006.01.008.
We previously reported the functional and radiographic outcomes of 21 young adults at an average of 7 years after open reduction and internal fixation of an intra-articular distal radius fracture (original study). The purpose of the current investigation was to evaluate the same cohort at an average of 15 years after surgery to evaluate the effect of additional time on both function and radiographic appearance.
We re-evaluated 16 of the original patients at an average of 15 years after surgery. Subjective assessment was performed with the Musculoskeletal Functional Assessment and the Hand Function Sort questionnaires. Objective assessment included a detailed physical examination and strength measurement. Standardized radiographs and computed tomography were used to assess wrist morphology, residual articular step and gap displacement, and the presence and degree of arthrosis.
Subjectively patients continued to function at a high level at the last follow-up evaluation: the average Musculoskeletal Functional Assessment score was 10 and 14 of the 16 patients functioned at a high level according to the Hand Function Sort. Strength and range of motion remained essentially unchanged from the original report. Radiocarpal arthrosis was noted in 13 of the 16 wrists and joint space was reduced an additional 67% compared with the 7-year follow-up evaluation. Nonetheless there continued to be no correlation between the presence or degree of arthrosis and upper-extremity function.
Radiocarpal arthrosis after intra-articular distal radius fractures can be expected to worsen over time. Despite joint space narrowing and evidence of advanced arthrosis, however, patients maintained a high level of function at the long-term follow-up evaluation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level II.
我们之前报告了21例年轻成人桡骨远端关节内骨折切开复位内固定术后平均7年的功能和影像学结果（原始研究）。本研究的目的是在平均术后15年对同一队列进行评估，以评价额外时间对功能和影像学表现的影响。
我们对16例原始患者在平均术后15年进行了重新评估。使用肌肉骨骼功能评估问卷和手功能分类问卷进行主观评估。客观评估包括详细的体格检查和力量测量。使用标准化X线片和计算机断层扫描评估腕关节形态、残余关节台阶和间隙移位以及关节病的存在和程度。
在最后一次随访评估中，患者主观上仍保持较高的功能水平：肌肉骨骼功能评估平均得分为10分，16例患者中有14例根据手功能分类功能水平较高。力量和活动范围与原始报告相比基本保持不变。16例腕关节中有13例出现桡腕关节病，与7年随访评估相比，关节间隙又减少了67%。然而，关节病的存在或程度与上肢功能之间仍然没有相关性。
桡骨远端关节内骨折后的桡腕关节病预计会随着时间的推移而恶化。然而，尽管关节间隙变窄且有晚期关节病的证据，但患者在长期随访评估中仍保持较高的功能水平。
研究类型/证据水平：预后性研究，二级证据。
