Ozer Kagan, Kiliç Ayhan, Sabel Allison, Ipaktchi Kyros
Department of Orthopedics and Department of Patient Safety and Quality, Denver Health Medical Center, University of Colorado, Denver, CO, USA.
J Hand Surg Am. 2011 Nov;36(11):1804-9. doi: 10.1016/j.jhsa.2011.08.011.
Two cohorts of patients who had corrective osteotomies and volar platings for malunited fractures of the distal radius were compared retrospectively to determine whether the time to union and the outcome were affected by bone allograft.
Patients in the first group (n = 14) did not receive any bone graft; patients in the second group (n = 14) had allograft bone chips following volar plating. Indications for surgery, surgical technique, and postoperative rehabilitation were the same in both groups. Volar cortical contact was maintained using a volar locking plate in all patients. Radiographic parameters of deformity correction, time to union, wrist and forearm range of motion, grip strength, patient-rated wrist evaluation and Disabilities of the Arm, Shoulder, and Hand questionnaire were used to evaluate the outcome before and after the surgery. Average follow-up time was 36 weeks. Patients who had diabetes, who smoked, who had a body mass index of more than 35, and who required lengthening for deformity correction were excluded from the study.
Osteotomies in both groups healed without loss of surgical correction. Final outcome and time to union revealed no significant differences, clinically or statistically, between the 2 groups. The Disabilities of the Arm, Shoulder, and Hand score was improved in both groups.
When volar cortical contact was maintained using a volar locked plate, bone allograft at the osteotomy site did not improve the final outcome.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
回顾性比较两组因桡骨远端骨折畸形愈合而接受截骨矫形及掌侧钢板固定的患者，以确定异体骨移植是否会影响骨折愈合时间及治疗效果。
第一组患者（n = 14）未接受任何骨移植；第二组患者（n = 14）在掌侧钢板固定后使用了异体骨碎片。两组患者的手术指征、手术技术及术后康复方案均相同。所有患者均使用掌侧锁定钢板维持掌侧皮质接触。采用畸形矫正的影像学参数、骨折愈合时间、腕关节和前臂活动范围、握力、患者自评腕关节评估以及上肢、肩部和手部功能障碍问卷来评估手术前后的治疗效果。平均随访时间为36周。患有糖尿病、吸烟、体重指数超过35以及需要延长截骨以矫正畸形的患者被排除在研究之外。
两组截骨均愈合，手术矫正效果无丢失。两组在临床及统计学上，最终治疗效果及骨折愈合时间均无显著差异。两组的上肢、肩部和手部功能障碍评分均有所改善。
当使用掌侧锁定钢板维持掌侧皮质接触时，截骨部位的异体骨移植并未改善最终治疗效果。
研究类型/证据水平：治疗性III级。
