Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
J Orthop Trauma. 2013 Dec;27(12):735-9. doi: 10.1097/BOT.0b013e31828e18a2.
The objective of this study was to determine whether intraoperative laxity of the distal radioulnar joint (DRUJ) is associated with adverse postoperative outcomes after volar plate fixation of a distal radius fracture (DRF) and 4 weeks of immobilization.
Prospective study with clinical and radiographic assessment.
Level 1 trauma center.
One hundred consecutive patients were treated by volar locking plate fixation at our institution for an unstable DRF from April 2007 to November 2009. Of these patients, 84 patients with a minimum follow-up of 12 months were enrolled in this study.
Intraoperative DRUJ laxity was evaluated using a radioulnar stress test after fixation of DRF using volar locking plate and splint immobilization of the forearm for 1 month in patients with intraoperative DRUJ laxity. Patients were allocated to an unstable group or stable group according to the presence of intraoperative DRUJ laxity.
Our primary outcome measure was disabilities of arm, shoulder, and hand score and the secondary outcome measures were wrist motion, grip strength, modified Mayo wrist score, visual analogue scale for wrist pain, and ongoing pain in the DRUJ.
Nineteen of the 84 study subjects were allocated to the unstable group and 65 to the stable group. No significant differences were observed between 2 groups in wrist range of motion, grip strength, modified Mayo wrist score, disabilities of arm, shoulder, and hand score, visual analogue scale score, and ongoing pain in the DRUJ at 1 year postoperatively.
In our series of patients treated with volar locking plate and immobilization of the forearm for 1 month in patients with intraoperative laxity of the DRUJ, laxity did not affect impairment, pain, or disability 1 year after fracture. However, the role of postoperative immobilization of the forearm is debatable and merits additional study.
Prognostic level I.
本研究旨在探讨桡骨远端关节（DRUJ）的术中松弛度与掌侧钢板固定桡骨远端骨折（DRF）及 4 周固定后不良术后结果之间的关系。
前瞻性研究，具有临床和影像学评估。
1 级创伤中心。
2007 年 4 月至 2009 年 11 月，我院采用掌侧锁定钢板治疗 100 例不稳定 DRF 患者。其中，84 例患者随访至少 12 个月，纳入本研究。
在 DRF 用掌侧锁定钢板固定后，采用桡尺骨应力试验评估术中 DRUJ 松弛度。对术中 DRUJ 松弛患者，采用掌侧锁定钢板固定和前臂夹板固定 1 个月。根据术中 DRUJ 松弛情况，将患者分为不稳定组或稳定组。
主要观察指标为上肢、肩和手残疾评分，次要观察指标为腕关节活动度、握力、改良 Mayo 腕关节评分、腕关节疼痛视觉模拟评分和 DRUJ 持续性疼痛。
84 例研究对象中，19 例被分配到不稳定组，65 例被分配到稳定组。两组患者在术后 1 年时腕关节活动度、握力、改良 Mayo 腕关节评分、上肢、肩和手残疾评分、视觉模拟评分和 DRUJ 持续性疼痛无显著差异。
在我们的系列病例中，对于术中 DRUJ 松弛的患者，采用掌侧锁定钢板固定和前臂固定 1 个月治疗，松弛度不会影响骨折 1 年后的损伤、疼痛或残疾。然而，术后前臂固定的作用仍存在争议，值得进一步研究。
预后 I 级。
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