Zyluk Andrzej, Janowski Piotr
Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie.
Chir Narzadow Ruchu Ortop Pol. 2007 Sep-Oct;72(5):327-34.
The objective of this study was comparing the results of the conservative (close reduction and immobilisation in the plaster splint) vs operative (percutaneous Kirschner-wiring) treatment of fractures of the distal radius. Sixty patients, 49 women (82%) and 11 men (18%), who sustained an isolated, displaced fractures were randomly allocated to operative (30 patients) or conservative (30 patients) treatment. All patients were followed up at 1.5, 3 and finally at 6 months after fracture. The following variables were analysed: rate of secondary displacement, wrist range of motion, fingers loss of flexion, total grip strength, dorsal or volar tilt, radial angulation and radial length on the X-ray. Function of the hand was assessed with DASH questionnaire, cold sensitivity with McCabe scale and final outcome in Gartland-Werley and Castaing complex scales. The rate of secondary displacement was considered a primary outcome measure.
Secondary displacement was noted in 8 patients (27%) treated conservatively, of whom 7 required surgery and those were withdrawn from the trial. Three fractures (10%) treated operatively displaced secondarily, but none required additional operation and all completed the follow-up. The rate of secondary displacement was statistically significantly (chi2 test, p < 0.05) more frequent in conservatively treated group. With regard to other analysed parameters, the statistically significant differences was found in total grip strength at 3 and 6 months assessments, and in DASH score at 6 months assessment, both favouring operative method. The remaining variables did not differ significantly between the groups treated conservatively and operatively.
Our results have demonstrated, that percutaneous Kirschner-wiring of fractures of the distal radius is superior to the conservative treatment, because statistically significantly reduces the risk of secondary displacement and allows to obtain a stronger grip and better hand function within 6 months after fracture.
本研究的目的是比较桡骨远端骨折保守治疗（闭合复位并用石膏夹板固定）与手术治疗（经皮克氏针内固定）的效果。60例患者，49名女性（82%）和11名男性（18%），均为单纯性移位骨折，被随机分为手术治疗组（30例患者）和保守治疗组（30例患者）。所有患者在骨折后1.5个月、3个月及最后6个月进行随访。分析以下变量：二次移位率、腕关节活动范围、手指屈曲丧失、总握力、背侧或掌侧倾斜、桡骨角及X线片上的桡骨长度。用DASH问卷评估手部功能，用麦凯布量表评估冷敏感性，用加特兰 - 韦利和卡斯坦综合量表评估最终结果。二次移位率被视为主要结局指标。
保守治疗的8例患者（27%）出现二次移位，其中7例需要手术，这些患者退出试验。手术治疗的3例骨折（10%）出现二次移位，但均无需再次手术，所有患者均完成随访。保守治疗组二次移位率在统计学上显著更高（卡方检验，p < 0.05）。关于其他分析参数，在3个月和6个月评估时的总握力以及6个月评估时的DASH评分方面发现有统计学显著差异，均有利于手术方法。保守治疗组和手术治疗组之间其余变量无显著差异。
我们的结果表明，桡骨远端骨折经皮克氏针内固定优于保守治疗，因为它在统计学上显著降低了二次移位的风险，并能在骨折后6个月内获得更强的握力和更好的手部功能。
