Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea.
J Bone Joint Surg Am. 2011 Apr 6;93(7):609-14. doi: 10.2106/JBJS.J.00613.
Calcium phosphate bone cement increases the stability of implant-bone constructs in patients with an osteoporotic fracture. The purpose of this randomized study was to determine whether augmentation of volar locking plate fixation with calcium phosphate bone cement has any benefit over volar locking plate fixation alone in patients older than sixty-five years of age who have an unstable distal radial fracture.
Forty-eight patients (fifty unstable distal radial fractures) were recruited for this study. The mean patient age was seventy-three years. Surgical procedures were randomized between volar locking plate fixation alone (Group 1) and volar locking plate fixation with injection of calcium phosphate bone cement (Group 2). The patients were assessed clinically at three and twelve months postoperatively. Clinical assessments included determinations of grip strength, wrist motion, wrist pain, modified Mayo wrist scores, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiographic evaluations were performed immediately postoperatively and at one year following surgery. The adequacy of the reduction was assessed by measuring radial inclination, volar angulation, and ulnar variance.
The two groups were comparable with regard to age, sex, fracture type, injury mechanism, and bone mineral density. No significant differences were observed between the groups with regard to the clinical outcomes at the three or twelve-month follow-up examination. No significant intergroup differences in radiographic outcomes were observed immediately after surgery or at the one-year follow-up visit. Furthermore, no complication-related differences were observed, and there were no nonunions.
Augmentation of metaphyseal defects with calcium phosphate bone cement after volar locking plate fixation offered no benefit over volar locking plate fixation alone in elderly patients with an unstable distal radial fracture.
磷酸钙骨水泥可增加骨质疏松性骨折患者中植入物-骨结构的稳定性。本随机研究的目的是确定在 65 岁以上、桡骨远端不稳定骨折的患者中，磷酸钙骨水泥是否能增强掌侧锁定板固定的效果。
本研究共纳入 48 例患者（50 例桡骨远端不稳定骨折）。患者平均年龄为 73 岁。手术程序在单纯掌侧锁定板固定（第 1 组）和掌侧锁定板固定加磷酸钙骨水泥注射（第 2 组）之间进行随机分组。术后 3 个月和 12 个月对患者进行临床评估。临床评估包括握力、腕关节活动度、腕关节疼痛、改良 Mayo 腕关节评分和上肢功能障碍（DASH）评分的测定。术后即刻和术后 1 年进行影像学评估。通过测量桡骨倾斜度、掌倾角和尺骨变异度来评估复位的充分性。
两组在年龄、性别、骨折类型、损伤机制和骨密度方面具有可比性。在术后 3 个月和 12 个月的随访检查中，两组的临床结果无显著差异。术后即刻和术后 1 年的影像学结果无显著组间差异。此外，未观察到与并发症相关的差异，也没有发生骨不连。
在老年桡骨远端不稳定骨折患者中，掌侧锁定板固定后用磷酸钙骨水泥增强干骺端缺损并不能比单纯掌侧锁定板固定带来更多的益处。
