Benson Leon S, Minihane Keith P, Stern Laura D, Eller Erik, Seshadri Roopa
Illinois Bone and Joint Institute, Evanston Northwestern Healthcare, Department of Orthopaedic Surgery, and Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Hand Surg Am. 2006 Oct;31(8):1333-9. doi: 10.1016/j.jhsa.2006.07.004.
To assess the clinical, radiographic, and functional outcome of treating intra-articular distal radius fractures with fragment-specific fixation.
A retrospective review of 81 patients with 85 intra-articular distal radius fractures who were treated with fragment-specific fixation was performed. Minimum time to follow-up evaluation was 1 year, with a mean time of 32 months. The immediate postoperative films were compared with those taken at the final follow-up evaluation. Radiographs of the uninjured wrist were also obtained at the final follow-up evaluation for comparison. Patients were examined for wrist and finger range of motion, deformity, and grip strength, and they completed a standard Disabilities of the Arm, Shoulder, and Hand outcome survey.
According to Gartland and Werley scoring there were 61 excellent and 24 good results. Flexion and extension of the surgically treated wrist at the final follow-up evaluation averaged 85% and 91%, respectively, of the uninjured wrist; grip strength averaged 92% compared with the uninjured side. The average Disabilities of the Arm, Shoulder, and Hand outcome score for the injured wrist was 9. Sixty-two percent of patients achieved a 100 degrees arc of flexion and extension and normal forearm rotation by postoperative week 6. Radiographic alignment was maintained between immediate postoperative and final follow-up films, and there were no cases of symptomatic arthritis at the final follow-up evaluation.
Fragment-specific fixation is a reasonable alternative for treating intra-articular fractures of the distal radius. At final follow-up evaluations, patients had good to excellent results with respect to range of motion, grip strength, radiographic alignment, and satisfaction scores. Stable fixation allowed starting active and passive motion of the wrist without compromising postoperative alignment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
评估采用骨折块特异性固定治疗桡骨远端关节内骨折的临床、影像学及功能结果。
对81例（85处）采用骨折块特异性固定治疗的桡骨远端关节内骨折患者进行回顾性研究。随访评估的最短时间为1年，平均时间为32个月。将术后即刻的X线片与末次随访评估时拍摄的X线片进行比较。在末次随访评估时还获取了未受伤手腕的X线片以作对照。对患者进行手腕和手指活动范围、畸形及握力检查，并让他们完成一份标准的上肢、肩部和手部功能障碍结局调查问卷。
根据Gartland和Werley评分，结果为优61例，良24例。在末次随访评估时，手术治疗手腕的屈伸活动分别平均达到未受伤手腕的85%和91%；与未受伤侧相比，握力平均为92%。受伤手腕的上肢、肩部和手部功能障碍结局评分平均为9分。62%的患者在术后第6周时达到了100度的屈伸弧度和正常的前臂旋转。术后即刻与末次随访X线片之间保持了影像学对线，在末次随访评估时没有出现症状性关节炎病例。
骨折块特异性固定是治疗桡骨远端关节内骨折的一种合理选择。在末次随访评估时，患者在活动范围、握力、影像学对线及满意度评分方面取得了良好至优异的结果。稳定的固定允许在不影响术后对线的情况下开始手腕的主动和被动活动。
研究类型/证据水平：治疗性IV级。
