van Aaken J, Beaulieu J-Y, Della Santa D, Kibbel O, Fusetti C
Hôpital universitaire de Genève, Switzerland.
Chir Main. 2008 Sep;27(4):160-6. doi: 10.1016/j.main.2008.05.005. Epub 2008 Jun 20.
Kirschner wire (K-wire) fixation is a common technique aimed at treating unstable distal radius fractures. We report our experience with extrafocal K-wire fixation in the treatment of unstable distal radius fractures in 34 patients (AO classification: 10 A2, 5 A3, 14 C1, and 5 C2). The patients' median age was 63 years (range, 16-87 years). K-wires remained in place for a median duration period of 42 days, and a splint was applied during 44 days in median. The median follow-up was 2.5 years (range, 1.3-5 years). At the final follow-up examination, all patients were assessed clinically and bilateral radiographs were taken. The median final range of motion was 69 degrees /64 degrees for extension/flexion, 88 degrees/82 degrees for pronation/supination and 36 degrees/21 degrees for ulnar/radial deviation. Grip strength was 81% of the contralateral side. Using the Gartland-Werley score, 12 patients (35%) had excellent results, 17 (50%) good, and five patients (15%) had fair results. The median final radiographic dorsal tilt was 4.5 degrees (range, 0-14 degrees) and 79% of patients had a loss of volar reduction (median 8 degrees). Radial inclination was in median 20 degrees (range, 10-32 degrees) with 82% of the patients with loss of reduction (median 5 degrees). Radial shortening was in median 0.9 mm (range, -2 to +5 mm) and 62% of patients had median loss of radial length of 1.1mm. Radial shortening was the major source of pain due to ulnar impingement. We found a high complication rate, with 15 patients (44%) suffering from at least one of the 30 reported complications. We did not find any direct correlation between radiographic results and mobility. Although good clinical outcome may be obtained, K-wire fixation cannot be routinely recommended.
克氏针固定是治疗桡骨远端不稳定骨折的常用技术。我们报告了34例桡骨远端不稳定骨折患者采用病灶外克氏针固定的治疗经验（AO分类：10例A2型、5例A3型、14例C1型和5例C2型）。患者的中位年龄为63岁（范围16 - 87岁）。克氏针留置的中位时间为42天，中位夹板固定时间为44天。中位随访时间为2.5年（范围1.3 - 5年）。在末次随访检查时，对所有患者进行临床评估并拍摄双侧X线片。末次随访时，伸展/屈曲的中位活动范围为69度/64度，旋前/旋后的中位活动范围为88度/82度，尺偏/桡偏的中位活动范围为36度/21度。握力为对侧的81%。采用Gartland-Werley评分，12例患者（35%）结果为优，17例（50%）为良，5例患者（15%）为可。末次随访时X线片的背侧倾斜度中位值为4.5度（范围0 - 14度），79%的患者掌侧复位丢失（中位值8度）。桡骨倾斜度中位值为20度（范围10 - 32度），82%的患者复位丢失（中位值5度）。桡骨短缩中位值为0.9毫米（范围 - 2至 + 5毫米），62%的患者桡骨长度中位丢失1.1毫米。桡骨短缩是尺骨撞击导致疼痛的主要原因。我们发现并发症发生率较高，15例患者（44%）至少出现了报告的30种并发症中的一种。我们未发现X线片结果与活动度之间存在直接相关性。尽管可能获得良好的临床结果，但克氏针固定不能常规推荐。
