Departement of Orthopaedic and Trauma Surgery, Reims University Hospital Center, Reims, France.
Orthop Traumatol Surg Res. 2012 Feb;98(1):61-7. doi: 10.1016/j.otsr.2011.09.018. Epub 2012 Jan 26.
Within the framework of a regional clinical study, the radiographic results of Py's and Kapandji's fixation techniques for dorsally displaced distal radius fractures were compared.
A prospective randomised monocenter and multi-operator study (phase III clinical trial) comparing the Py's (isoelastic pinning) and Kapandji's (intrafocal pinning) techniques was conducted. Two comparable groups were established: the Py (P) and Kapandji (K) groups. The frontal radial tilt (FRT), sagittal radial tilt (SRT), radial length and ulnar variance were measured. Analysis of subjective and objective function was based on the range of motion according to six parameters, the DASH and Jakim scoring systems. The quality of anatomical restoration was assessed arthroscopically during pin removal at 6 postoperative weeks.
Ninety-seven patients were included in the study with a follow-up period of 1 year. The preoperative FRT was 15.17° and SRT was -19.2°. At one-year follow-up, the FRT was 25.5° in the PY group and 22.6° in the K group (p=0.009), the SRT was 10.5° in the PY group and 6.7° in the K group (p=0.04). For fractures with postero-medial fragment and Gerard Marchand's fractures, the DASH score at last follow-up was 22 in the Py group, 42 and 32 respectively in the K group. The Jakim score was 71 in the PY group and 58 in the K group (p=0.03) for fractures with postero-medial fragment. There was no report of tendon rupture in our study.
Besides the good results achieved with both pinning techniques in the treatment of distal radius fractures, this series also underlines the importance to adapt the type of fixation to the fracture pattern and patient.
Pinning for treating dorsally displaced distal radius fractures appears a suitable option provided that the indications and the surgical technique for each method are respected. However, pinning is not suitable for all types of fractures.
Level II. Randomised prospective therapeutic study.
在一项区域性临床研究框架内，比较了 Py 氏和 Kapandji 氏固定技术治疗背侧移位的桡骨远端骨折的放射学结果。
进行了一项前瞻性随机单中心和多操作者研究（III 期临床试验），比较了 Py 氏（等弹性钉固定）和 Kapandji 氏（病灶内钉固定）技术。建立了两个可比的组：Py（P）组和 Kapandji（K）组。测量掌侧桡偏角（FRT）、矢状桡偏角（SRT）、桡骨长度和尺侧偏移。根据六个参数的活动范围，基于 DASH 和 Jakim 评分系统，对主观和客观功能进行分析。在术后 6 周取出固定钉时，通过关节镜评估解剖复位质量。
97 例患者纳入研究，随访时间为 1 年。术前 FRT 为 15.17°，SRT 为-19.2°。在 1 年随访时，PY 组的 FRT 为 25.5°，K 组为 22.6°（p=0.009），PY 组的 SRT 为 10.5°，K 组为 6.7°（p=0.04）。对于后内侧骨块和 Gerard Marchand 型骨折，最后随访时 Py 组的 DASH 评分为 22，K 组分别为 42 和 32。对于后内侧骨块骨折，PY 组的 Jakim 评分为 71，K 组为 58（p=0.03）。本研究无肌腱断裂报告。
除了两种固定技术治疗桡骨远端骨折均取得良好效果外，本系列研究还强调了根据骨折类型和患者情况选择固定类型的重要性。
对于背侧移位的桡骨远端骨折，钉固定术是一种合适的选择，前提是要遵守每种方法的适应证和手术技术。然而，钉固定术并不适合所有类型的骨折。
II 级。随机前瞻性治疗研究。
