Voigt C, Lill H
Klinik für Unfall- und Wiederherstellungschirurgie, Friederikenstift Hannover, Humboldtstrasse 5, 30169 Hannover, Deutschland.
Unfallchirurg. 2006 Oct;109(10):845-6, 848-54. doi: 10.1007/s00113-006-1163-9.
The purpose of this retrospective study was to compare the outcome of open reduction and internal fixation (ORIF) followed immediately by physiotherapy and of percutaneous K-wire-fixation and casting for unstable distal radius fractures in elderly patients, considering the results both in general, for all such fractures, and selectively for A3 and C2 fractures.
Follow-up examinations were performed 26 (18-48) months after surgery in 43 patients (median age 67 (60-83) years) treated with K-wire fixation and 9 (5-17) months after surgery in 46 patients (median age 76 (60-90) years) treated with ORIF, and the outcome of each was recorded as Disabilities of the Arm, Shoulder and Hand (DASH), Gartland-Werley and Castaing scores; the radiological loss of correction was also assessed. Statistical analysis was performed first without reference to the specific type of fracture for the K-wire- and the total ORIF -groups, and then selectively for A3 and C2 -fractures only; in the second analysis the patients were divided into three groups: KD, ORIF with and ORIF without angular stability.
The Garland-Werley and Castaing scores do not indicate any significant difference between the procedures specified. According to the Garland-Werley score 37 patients (86%) treated by K-wire fixation and 39 (85%) treated by ORIF achieved "excellent" and "good" results; according to the Castaing score there were 33 (77%) "good" results after K-wire fixation and 34 (74%) good results after ORIF. The radiological loss of correction (K-wire fixation/ORIF) as measured by the radial inclination (median 2/2.5 degrees), the palmar tilt (median 3/5 degrees) and the radial shortening (median 1/1 degrees mm) do not differ significantly. Suboptimal radiological results do not always correlate with results that are only "fair" or "poor". The non-fracture-specific DASH score suggests a higher degree of patient satisfaction after K-wire fixation (7 [0-87] points) than after ORIF (17 [0-82] points), which is not confirmed by fracture-specific evaluation. There is a significantly earlier return to the "activities of daily living" (4 as against 8 weeks) after ORIF.
All the treatments compared are suitable for the treatment of A3 and C2 fractures. The important advantages of ORIF are the early functional physiotherapy without casting and without obligatory second surgery and the earlier return to "activities of daily living", which are all of decisive importance for older patients, who are the ones most frequently affected.
本回顾性研究的目的是比较老年患者不稳定桡骨远端骨折采用切开复位内固定（ORIF）后立即进行物理治疗与经皮克氏针固定加石膏固定的效果，既要考虑所有此类骨折的总体结果，也要选择性地考虑A3和C2骨折的结果。
对43例（中位年龄67（60 - 83）岁）接受克氏针固定治疗的患者在术后26（18 - 48）个月进行随访检查，对46例（中位年龄76（60 - 90）岁）接受ORIF治疗的患者在术后9（5 - 17）个月进行随访检查，并将各自的结果记录为上肢、肩部和手部功能障碍（DASH）、Gartland - Werley和Castaing评分；还评估了放射学上的矫正丢失情况。首先对克氏针组和整个ORIF组不参考骨折的具体类型进行统计分析，然后仅选择性地对A3和C2骨折进行分析；在第二次分析中，将患者分为三组：KD、具有角稳定性的ORIF组和不具有角稳定性的ORIF组。
Garland - Werley和Castaing评分表明所指定的两种治疗方法之间没有显著差异。根据Garland - Werley评分，43例接受克氏针固定治疗的患者中有37例（86%）和46例接受ORIF治疗的患者中有39例（85%）取得了“优秀”和“良好”的结果；根据Castaing评分，克氏针固定后有33例（77%）“良好”结果，ORIF后有34例（74%）良好结果。通过桡骨倾斜度（中位值2/2.5度）、掌倾角（中位值3/5度）和桡骨缩短（中位值1/1度毫米）测量的放射学矫正丢失（克氏针固定/ORIF）没有显著差异。放射学结果欠佳并不总是与仅为“一般”或“差”的结果相关。非骨折特异性的DASH评分表明克氏针固定后患者的满意度（7 [0 - 87]分）高于ORIF后（17 [0 - 82]分），但骨折特异性评估未证实这一点。ORIF后显著更早恢复到“日常生活活动”（4周对比8周）。
所有比较的治疗方法都适用于A3和C2骨折的治疗。ORIF的重要优点是无需石膏固定且无需二次手术即可早期进行功能物理治疗，以及更早恢复到“日常生活活动”，这些对受影响最频繁的老年患者具有决定性意义。
