Klinik für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann Strasse 13, D-67071 Ludwigshafen, Germany.
Injury. 2011 Apr;42(4):385-92. doi: 10.1016/j.injury.2010.10.010. Epub 2010 Dec 8.
The aim of the study was to compare radiological and functional outcomes between volar and dorsal surgical fixation of distal radius fractures using low-profile, fixed-angle implants.
A total of 305 distal radius fracture patients were treated with Synthes locking compression plate (LCP) 2.4- or 3.5-mm fixation using either a volar (n=266) or dorsal (n=39) approach. The patients were examined at 6 months, 1 and 2 years for radiological assessment of fracture healing, alignment, reduction and arthritis, as well as the determination of various functional outcome scores.
Both groups were comparable with respect to baseline and injury characteristics. The complication rate was higher for the volar approach (15%). No significant differences were observed for Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form (36) Health Survey (SF-36) scores, pain, arthritis grade, grip strength and radiological measurements. However, a significantly better functional outcome represented by a low mean Gartland and Werley score was observed for the volar approach after 6 and 12 months. Significantly higher percentages of dorsal extension, palmar flexion, ulnar deviation and supination angle (relative to the mean contralateral healthy wrist) were also reported for volar approach patients at the 6-month follow-up.
Volar internal fixation of distal radius fractures with LCP DR implants can result in earlier and better functional outcome compared with the dorsal approach, yet is associated with a higher incidence of complications. After 2 years, these differences are no longer observed between the two surgical methods.
本研究旨在比较使用低切迹、固定角度植入物经掌侧和背侧入路治疗桡骨远端骨折的影像学和功能结果。
共有 305 例桡骨远端骨折患者接受了 Synthes 锁定加压钢板（LCP）2.4 或 3.5 毫米固定，其中掌侧入路 266 例，背侧入路 39 例。在 6 个月、1 年和 2 年时对患者进行影像学评估，评估骨折愈合、对线、复位和关节炎情况，以及各种功能结果评分。
两组在基线和损伤特征方面具有可比性。掌侧入路的并发症发生率较高（15%）。在手臂残疾、肩部和手部（DASH）和简明健康调查（SF-36）评分、疼痛、关节炎分级、握力和影像学测量方面，两组之间无显著差异。然而，掌侧入路在 6 个月和 12 个月时的 Gartland 和 Werley 评分均值较低，表明功能结果更好。在 6 个月的随访中，掌侧入路患者的背侧伸展、掌侧屈曲、尺侧偏斜和旋前角度（相对于对侧健康手腕的平均值）的百分比也显著更高。
与背侧入路相比，LCP DR 植入物经掌侧内固定治疗桡骨远端骨折可更早获得更好的功能结果，但与更高的并发症发生率相关。2 年后，两种手术方法之间不再存在这些差异。
