Chung Kevin C, Squitieri Lee, Kim H Myra
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI 48109-0340, USA.
J Hand Surg Am. 2008 Jul-Aug;33(6):809-19. doi: 10.1016/j.jhsa.2008.02.016.
Despite the high prevalence and impact of distal radius fractures (DRFs) on older patients, the currently available literature regarding DRFs in older adults lacks adequate comparative treatment data. The purpose of this prospective, controlled outcomes study is to compare outcomes using the volar locking plating system (VLPS) for DRFs in both older and younger adults and to assert the eligibility of older patients for surgical management with the VLPS.
Consecutive, eligible patients were enrolled into our prospective study over a 2-year period on the basis of strict inclusion and exclusion criteria. Subjects were entered into 2 cohorts based on age: 20-40 years and >60 years. Patient outcomes and complication rates were evaluated at 3, 6, and 12 months after surgery. Outcome measures included the Michigan Hand Outcomes Questionnaire (MHQ), grip strength, active wrist and forearm range of motion, the Jebsen-Taylor test, and radiographic parameters.
Fifty-five patients (30 young and 25 older adults) with unilateral, inadequately reduced DRFs were enrolled and received surgical treatment with the VLPS. We observed no statistically significant difference in any of the outcomes for all 3 follow-up periods, except the Jebsen-Taylor test, which displayed a trend toward a worse outcome in the older-age cohort. Whereas older patients continued to improve throughout their 12-month postoperative visits, younger patients achieved their maximum recovery during the 6-month follow-up period, suggesting different recovery patterns. At the 12-month assessment, older patients were able to achieve a higher mean MHQ score than their younger counterparts (normalized mean: 85% and 82%, respectively). Complication rates were similar between the 2 groups for all 3 time periods, with most occurring on or before the 3-month postoperative visit.
This study indicates that the VLPS is successful in managing DRFs in older patients without increased complications compared to younger patients. For older patients without prohibitive surgical risks, internal fixation using the VLPS yields comparable outcomes to younger patients. However, these conclusions do not necessarily apply to other surgical techniques used to manage DRFs in older adults.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
尽管桡骨远端骨折（DRF）在老年患者中发病率高且影响大，但目前关于老年成人DRF的文献缺乏足够的对比治疗数据。这项前瞻性对照结局研究的目的是比较使用掌侧锁定钢板系统（VLPS）治疗老年和年轻成人DRF的结局，并确定老年患者使用VLPS进行手术治疗的适用性。
在2年期间，根据严格的纳入和排除标准，将连续符合条件的患者纳入我们的前瞻性研究。根据年龄将受试者分为2个队列：20 - 40岁和60岁以上。在术后3、6和12个月评估患者结局和并发症发生率。结局指标包括密歇根手部结局问卷（MHQ）、握力、腕关节和前臂主动活动范围、杰布森 - 泰勒测试以及影像学参数。
55例单侧、复位不佳的DRF患者（30例年轻成人和25例老年成人）入组并接受了VLPS手术治疗。除杰布森 - 泰勒测试外，在所有3个随访期的任何结局指标上，我们均未观察到统计学上的显著差异，杰布森 - 泰勒测试显示老年队列的结局有变差的趋势。老年患者在术后12个月的随访中持续改善，而年轻患者在6个月随访期达到最大恢复，提示恢复模式不同。在12个月评估时，老年患者能够获得比年轻患者更高的平均MHQ评分（标准化均值分别为85%和82%）。在所有3个时间段内，两组的并发症发生率相似，大多数并发症发生在术后3个月或之前。
本研究表明，与年轻患者相比，VLPS成功治疗老年患者的DRF且并发症未增加。对于没有过高手术风险的老年患者，使用VLPS进行内固定产生的结局与年轻患者相当。然而，这些结论不一定适用于用于治疗老年成人DRF的其他手术技术。
研究类型/证据水平：治疗性II级。
