Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Paksima N
Department of Orthopaedic Surgery The New York University Hospital for Joint Diseases, 301 East 17th Street, New York, New York 10003, USA.
J Bone Joint Surg Br. 2008 Sep;90(9):1214-21. doi: 10.1302/0301-620X.90B9.20521.
We performed a prospective, randomised trial to evaluate the outcome after surgery of displaced, unstable fractures of the distal radius. A total of 280 consecutive patients were enrolled in a prospective database and 88 identified who met the inclusion criteria for surgery. They were randomised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws. Both groups were similar in terms of age, gender, hand dominance, fracture pattern, socio-economic status and medical co-morbidities. Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist, this advantage diminished with time and in absolute terms the difference in range of movement was clinically unimportant. Radiologically, there were no clinically significant differences in the reductions, although more patients with AO/OTA (Orthopaedic Trauma Association) type C fractures were allocated to the external fixation group. The function at one year was similar in the two groups. No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group.
我们进行了一项前瞻性随机试验，以评估桡骨远端移位不稳定骨折术后的结果。共有280例连续患者被纳入前瞻性数据库，其中88例符合手术纳入标准。他们被随机分为两组，一组接受桥接外固定加克氏针辅助固定，另一组接受掌侧锁定钢板螺钉固定。两组在年龄、性别、利手、骨折类型、社会经济状况和合并症方面相似。虽然掌侧钢板固定治疗的患者在腕关节活动范围方面早期有统计学意义的改善，但这种优势随时间减弱，从绝对数值来看，活动范围的差异在临床上并不重要。在影像学方面，复位情况无临床显著差异，尽管更多AO/OTA（骨科创伤协会）C型骨折患者被分配到外固定组。两组一年时的功能相似。两种治疗方法均未显示出明显优势，但外固定组再次手术的需求较少。
