Department of Trauma Surgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Austria.
Arch Orthop Trauma Surg. 2011 Aug;131(8):1121-6. doi: 10.1007/s00402-010-1211-3. Epub 2010 Dec 15.
Intra-articular malunion with step off and gap formation is claimed to be crucial for radiocarpal degeneration. In addition to well-defined intraarticular malunion, the shape of the distal radius is important for unaffected wrist function. In typical intra-articular fracture patterns with a dorsoulnar and palmar ulnar fragment, alterations of the shape of the articular surface, in a kind of a cavity, without obvious step off can be observed. The aim of the present study is to determine the residual articular deformity following intra-articular radius fractures and to analyze their impact on the final clinical and radiological outcome.
Eighty one patients with dorsally displaced distal intraarticular radius fractures were followed up for a mean period of 9 years. Surgical treatment of all patients included open reduction, plate fixation and corticocancellous bone grafting. Radiological measurements included palmar tilt, radial inclination and radial shortening as defined by ulnar variance, intra-articular Stepps and the measurement of the anteroposterior distance of the radial joint surface. Clinical assessment included active range of motion (ARM) of the wrist, pain according to a visual analogue scale (VAS), grip power, working ability, Disability of Arm, Shoulder and Hand Score (DASH Score).
Articular malunion in the form of a cavity in the sagittal plane measured 4.8 mm, 1.3 mm more than on the non-injured side. Anteroposterior distance measured 20.6 mm, 2.1 mm more than on the non-injured side. Articular step-off and gap was noticed in 11 patients. At the final follow-up examination, there was a significant difference in articular cavity depth and the anteroposterior distance between arthritis stage I and II. Arthritis stage was associated with the range of motion (ROM) in the sagittal plane, but had no significant influence on the DASH, pain level, grip strength and ROM in the frontal plane.
ORIF leads to predictable results in the restoration of length and form of the distal radius. Increasing the articular cavity depth should be avoided to prevent degenerative arthritis at the radiocarpal joint at long-term follow-up visits.
有研究声称，关节内对位不良伴台阶形成和间隙是导致桡腕关节退变的关键。除了明确的关节内对位不良外，桡骨远端的形状对于腕关节的正常功能也很重要。在典型的关节内骨折模式中，存在背侧和掌侧尺侧骨块，关节面的形状会发生改变，呈现出一种类似“腔隙”的状态，而没有明显的台阶。本研究旨在确定关节内桡骨骨折后的残余关节畸形，并分析其对最终临床和影像学结果的影响。
81 例背侧移位的关节内桡骨远端骨折患者接受随访，平均随访时间为 9 年。所有患者均接受切开复位、钢板固定和皮质松质骨移植治疗。影像学测量包括掌倾角、桡骨倾斜角和尺骨变异引起的桡骨缩短、关节内 Stepps 测量值和桡骨关节面前后距离。临床评估包括腕关节主动活动范围（ROM）、视觉模拟评分（VAS）疼痛、握力、工作能力、手臂、肩部和手部残疾（DASH）评分。
矢状面关节畸形呈“腔隙”样，测量值为 4.8mm，比健侧多 1.3mm。前后距离为 20.6mm，比健侧多 2.1mm。11 例患者出现关节台阶和间隙。在最终随访检查中，关节炎Ⅰ期和Ⅱ期患者的关节腔深度和前后距离存在显著差异。关节炎分期与矢状面 ROM 相关，但对 DASH、疼痛程度、握力和额状面 ROM 无显著影响。
切开复位内固定可有效恢复桡骨远端的长度和形态。应避免增加关节腔深度，以预防远期随访时桡腕关节退行性关节炎的发生。
