Glickel Steven Z, Catalano Louis W, Raia Frank J, Barron O Alton, Grabow Ryan, Chia Benjamin
CV Starr Hand Surgery Center, St. Luke's-Roosevelt Hospital, New York, NY, USA.
J Hand Surg Am. 2008 Dec;33(10):1700-5. doi: 10.1016/j.jhsa.2008.08.002.
The purpose of this study was to review the long-term outcomes of patients with distal radius fractures treated with closed reduction and percutaneous pinning.
We retrospectively reviewed 54 patients with 55 AO type A2, A3, C1, or C2 distal radius fractures treated with closed reduction and percutaneous pinning. The average age of the patients was 57 years. All patients returned for follow-up examination at an average of 59 months, with a minimum of 22 months. Measurements included active range of motion, grip strength, pain assessment, Disabilities of the Arm, Shoulder, and Hand scores, and final radiographic assessment. The paired t-test was used to determine significant differences.
All fractures healed within 6 weeks. Active range of motion and grip strength of the injured wrist were statistically equal to those of the uninjured wrist for each of the parameters except wrist flexion and forearm supination. However, the difference in wrist flexion was 5 degrees and the difference in supination was 4 degrees , both of which are of little clinical importance. Eighty-five percent of patients were pain free. Radiographic parameters comparing the immediate postoperative view with the views taken at final follow-up showed no significant differences. One patient required reoperation for loss of reduction after a fall in the preoperative period, and 3 others had minor complications.
Patients treated with closed reduction and percutaneous pinning for distal radius fractures had excellent range of motion, normal Disabilities of the Arm, Shoulder, and Hand scores, and no significant differences in the radiographic parameters between fracture fixation and fracture healing. Complications were few. Pinning is an efficacious, low-cost treatment option for 2- and 3-part distal radius fractures with excellent long-term results.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在回顾采用闭合复位及经皮穿针治疗桡骨远端骨折患者的长期疗效。
我们回顾性分析了54例患者的55例AO A2、A3、C1或C2型桡骨远端骨折，均采用闭合复位及经皮穿针治疗。患者平均年龄57岁。所有患者平均在59个月时进行随访复查，最短随访时间为22个月。测量指标包括主动活动范围、握力、疼痛评估、上肢、肩部和手部功能障碍评分以及最终影像学评估。采用配对t检验确定显著差异。
所有骨折均在6周内愈合。除腕关节屈曲和前臂旋后外，受伤腕关节的主动活动范围和握力在各参数上与未受伤腕关节在统计学上无差异。然而，腕关节屈曲差异为5度，旋后差异为4度，两者在临床上均无重要意义。85%的患者无痛。比较术后即刻与最终随访时影像学参数，未发现显著差异。1例患者在术前跌倒后因复位丢失需要再次手术，另外3例有轻微并发症。
采用闭合复位及经皮穿针治疗桡骨远端骨折的患者具有良好的活动范围、正常的上肢、肩部和手部功能障碍评分，骨折固定与骨折愈合之间的影像学参数无显著差异。并发症较少。穿针是治疗2部分和3部分桡骨远端骨折的有效、低成本治疗选择，长期效果良好。
研究类型/证据水平：治疗性IV级。
