Massachusetts General Hospital, Harvard Medical School, 2100 Yawkey Building, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:96-106. doi: 10.2106/JBJS.I.01340.
In the past decade, there has been a trend toward open reduction and internal fixation of unstable distal radial fractures. There are now more than thirty different implant designs specific for the fixation of distal radial fractures. A multicenter prospective study of a case series was conducted to determine the efficacy of the operative management of distal radial fractures stabilized with 2.4-mm locking plates.
One hundred and fifty patients were entered into the study over a two-year period. The mean age of these patients was fifty-one years, and the cohort included eighty-eight women and sixty-two men. Eighty-six patients sustained a low-energy injury. Seventy-one percent of the fractures in the series were intra-articular and were Type C according to the Müller-AO Comprehensive Classification. The follow-up evaluations, which were conducted at six weeks, six months, one year, and two years, included assessments of pain, motion, grip strength, and standard radiographs. Gartland and Werley scores were recorded at six months and one and two years, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were recorded at one and two years.
One hundred and twenty-five patients (83%) had a complete follow-up at six months; 121 (81%), at one year; and 117 (78%), at two years. Significant improvements in motion, grip strength, and patient satisfaction were observed between six months and one year, but further improvements were not seen at the two-year follow-up examination. The mean DASH score changed from a preinjury baseline of 2 points to 8 points at one year and 7 points at two years (p < 0.0001). The mean Gartland and Werley score improved significantly from 4 points at six months to 2 points at two years. Of the 102 intra-articular fractures examined in the immediate postoperative period, twenty had a step-off of <or=2 mm and seven had a step-off of >2 mm. Of the seventy-one intra-articular fractures seen at two years, sixty-one had no step-off, five had a step-off of <or=2 mm, and five had a step-off of >2 mm. Twenty-seven percent of the patients showed an increase of at least one grade in radiographic signs of arthritis at two years. There were twenty-eight complications, twenty of which were considered minor. Tendon inflammation occurred in nine patients. There were two tendon ruptures, one of which was due to a prominent dorsal screw tip placed through a volar plate and one of which was due to a prominent volar plate. Loss of reduction occurred in two patients, and screw loosening occurred in two patients.
Internal fixation of displaced distal radial fractures with implants featuring locking screw fixation can result in good-to-excellent outcomes with a limited number of complications.
在过去的十年中，不稳定的桡骨远端骨折的治疗趋势已经转向切开复位内固定。现在有三十多种不同的植入物设计专门用于固定桡骨远端骨折。一项多中心前瞻性病例系列研究旨在确定使用 2.4 毫米锁定钢板固定桡骨远端骨折的手术治疗效果。
在两年的时间里，共有 150 名患者入组。这些患者的平均年龄为 51 岁，其中 88 名女性，62 名男性。86 名患者为低能量损伤。该系列骨折中 71%为关节内骨折，根据 Müller-AO 综合分类法为 C 型。在 6 周、6 个月、1 年和 2 年的随访评估中，包括疼痛、运动、握力和标准 X 线片的评估。在 6 个月和 1 年和 2 年时记录 Gartland 和 Werley 评分，在 1 年和 2 年时记录残疾程度（手臂、肩部和手）（DASH）评分。
125 名（83%）患者在 6 个月时完成了完整随访；121 名（81%）患者在 1 年时完成了完整随访；117 名（78%）患者在 2 年时完成了完整随访。在 6 个月至 1 年期间，运动、握力和患者满意度均有显著改善，但在 2 年随访检查中未见进一步改善。DASH 评分从术前基线的 2 分降至 1 年时的 8 分和 2 年时的 7 分（p<0.0001）。Gartland 和 Werley 评分从 6 个月时的 4 分显著改善至 2 年时的 2 分。在术后即刻检查的 102 例关节内骨折中，20 例有<或=2 毫米的台阶，7 例有>2 毫米的台阶。在 71 例随访 2 年的关节内骨折中，61 例无台阶，5 例有<或=2 毫米的台阶，5 例有>2 毫米的台阶。27%的患者在 2 年时出现至少一个等级的关节炎放射学征象加重。有 28 种并发症，其中 20 种为轻微并发症。9 例患者出现肌腱炎。有 2 例肌腱断裂，其中 1 例是由于背侧螺钉尖端穿过掌侧钢板突出，另 1 例是由于掌侧钢板突出。2 例患者出现复位丢失，2 例患者出现螺钉松动。
使用具有锁定螺钉固定的植入物固定移位的桡骨远端骨折可获得良好至优秀的结果，并发症数量有限。
