Mirza Ather, Jupiter Jesse B, Reinhart Mary Kate, Meyer Patricia
St Catherine of Siena Medical Center, Smithtown, NY, USA.
J Hand Surg Am. 2009 Apr;34(4):603-16. doi: 10.1016/j.jhsa.2008.12.020.
To present the preliminary findings of distal radius fractures (DRF) treated with percutaneous cross-pin fixation and a nonbridging external fixator, the Cross-Pin Fixation (CPX) system.
Thirty-five consecutive patients with 37 DRFs were selected from a series of 51 DRFs for closed reduction, percutaneous pinning, and external fixation with the CPX system. Outcome was determined by studying (1) radiological measurements of radial height, palmar tilt, radial inclination and ulnar variance (UV); (2) grip and pinch strength; (3) wrist active range of motion; and (4) patient outcome instruments-the Patient-Rated Wrist Hand Evaluation and the Disabilities of the Arm, Shoulder, and Hand.
We are reporting on 21 patients, 13 females and 8 males, mean age 54 years (range, 27 to 87 y) with AO type fractures A2, B2, B3, C1, C2, and C3. Follow-up was a minimum of 1 year (range, 12 to 36 months). Wrist rehabilitation began at a mean of 10 days (range, 4 to 16 d) after surgery. There was no loss of reduction. Final mean grip and lateral pinch strength recovered 86% and 94%, respectively, and active range of motion increased to a minimum of 89% of the noninjured side. Disabilities of the Arm, Shoulder, and Hand showed change in functional status (minimal detectable change at 95% confidence level) at 4 and 12 weeks. The Patient-Rated Wrist Hand Evaluation results reported resumption of usual activities in the early postoperative period. One patient developed type I complex regional pain syndrome, which resolved, and one patient had residual transient mild superficial radial nerve sensitivity. There were no pin track infections, nonunions, or tendon injuries. All patients returned to their prior employment and activities.
The CPX system is a minimally invasive technique of closed reduction and internal fixation for displaced, reducible extra-articular and nondisplaced and displaced reducible intra-articular fractures of the distal radius, allowing rehabilitation of the wrist and resumption of usual activities while maintaining fracture reduction.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
介绍采用经皮交叉克氏针固定和非桥接外固定器（交叉克氏针固定（CPX）系统）治疗桡骨远端骨折（DRF）的初步研究结果。
从51例DRF患者中连续选取35例患者的37处骨折进行闭合复位、经皮穿针及CPX系统外固定。通过研究以下方面来确定治疗结果：（1）桡骨高度、掌倾角、桡骨倾斜度和尺骨变异（UV）的影像学测量；（2）握力和捏力；（3）腕关节活动范围；（4）患者预后评估工具——患者自评腕手评估量表以及上肢、肩部和手部功能障碍评估量表。
我们报告了21例患者，其中女性13例，男性8例，平均年龄54岁（范围为27至87岁），骨折类型为AO分型的A2、B2、B3、C1、C2和C3型。随访时间至少为1年（范围为12至36个月）。腕关节康复平均在术后10天（范围为4至16天）开始。复位无丢失。最终平均握力和侧捏力分别恢复至86%和94%，活动范围增加至至少健侧的89%。上肢、肩部和手部功能障碍评估量表显示在4周和12周时功能状态有变化（95%置信水平下的最小可检测变化）。患者自评腕手评估量表结果显示术后早期即可恢复日常活动。1例患者发生I型复杂性区域疼痛综合征，后痊愈，1例患者残留短暂性轻度桡浅神经感觉异常。未发生针道感染、骨不连或肌腱损伤。所有患者均恢复了之前的工作和活动。
CPX系统是一种用于桡骨远端移位、可复位的关节外骨折以及无移位和移位可复位关节内骨折的闭合复位和内固定的微创技术，可使腕关节进行康复训练并恢复日常活动，同时维持骨折复位。
研究类型/证据水平：治疗性IV级。
