Souer J Sebastiaan, Ring David, Matschke Stefan, Audige Laurent, Maren-Hubert Marta, Jupiter Jesse
Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
J Hand Surg Am. 2010 Mar;35(3):398-405. doi: 10.1016/j.jhsa.2009.11.023. Epub 2010 Feb 7.
Open reduction and locked volar plate and screw fixation is a popular treatment method for extra-articular distal radius fractures with dorsal metaphyseal comminution. In this study, we compared the use of a titanium 2.4-mm precontoured plate with that of a stainless-steel oblique 3.5-mm T-shaped plate to test the null hypothesis that there would be no difference in wrist function or upper extremity-specific health status in the internal fixation of AO-type A3.2 distal radius fractures.
We retrospectively analyzed 24 patients treated with a 2.4-mm titanium plate and 38 patients treated with a 3.5-mm stainless-steel plate for an extra-articular and dorsally angulated distal radius fracture, from data gathered in a prospective cohort study of plate and screw fixation of distal radius fractures. The 2 cohorts were analyzed for differences in motion, grip strength, pain, Gartland and Werley score, Disabilities of the Arm, Shoulder, and Hand score, and Short Form-36 score at 6, 12, and 24 months of follow-up. Group differences and their change over time were determined using regression analysis and the likelihood ratio test.
There were no significant differences in wrist function and arm-specific health status between patients treated with a 2.4-mm plate and those treated with a 3.5-mm plate at 6, 12, or 24 months of follow-up. However, we observed a trend toward greater wrist flexion at 1 year (66 degrees vs 55 degrees ; p=.07) and greater flexion-extension arc (137 degrees vs 123 degrees ; p=.08) and pronation-supination arc (172 degrees vs 160 degrees ; p=.07) at 24 months after surgery in patients treated with a 2.4-mm plate.
Patients with a dorsally angulated extra-articular distal radius facture can expect similar results when treated with either a precontoured 2.4-mm titanium plate or a 3.5-mm stainless-steel T-shaped plate.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
切开复位并用锁定掌侧钢板及螺钉固定是治疗伴有背侧干骺端粉碎的桡骨远端关节外骨折的一种常用方法。在本研究中，我们比较了使用2.4毫米预塑形钛板与3.5毫米不锈钢斜T形钢板的情况，以检验零假设，即AO型A3.2桡骨远端骨折内固定时，腕关节功能或上肢特定健康状况不会存在差异。
我们从一项关于桡骨远端骨折钢板及螺钉固定的前瞻性队列研究收集的数据中，回顾性分析了24例采用2.4毫米钛板治疗的患者以及38例采用3.5毫米不锈钢板治疗的桡骨远端关节外背侧成角骨折患者。对这两个队列在随访6个月、12个月和24个月时的活动度、握力、疼痛、Gartland和Werley评分、上肢、肩部和手部功能障碍评分以及简明健康状况调查36项评分的差异进行分析。使用回归分析和似然比检验确定组间差异及其随时间的变化。
在随访6个月、12个月或24个月时，使用2.4毫米钢板治疗的患者与使用3.5毫米钢板治疗的患者在腕关节功能和上肢特定健康状况方面无显著差异。然而，我们观察到，在术后24个月时，使用2.4毫米钢板治疗的患者有在1年时腕关节屈曲度更大（66度对55度；p = 0.07）以及屈伸弧更大（137度对123度；p = 0.08）和旋前旋后弧更大（172度对160度；p = 0.07）的趋势。
伴有背侧成角的桡骨远端关节外骨折患者，采用预塑形2.4毫米钛板或3.5毫米不锈钢T形钢板治疗可获得相似结果。
研究类型/证据水平：治疗性III级。
