Division of Orthopaedic and Accident Surgery, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom. E-mail address for A. Karantana:
J Bone Joint Surg Am. 2013 Oct 2;95(19):1737-44. doi: 10.2106/JBJS.L.00232.
The aim of this study was to compare the outcomes of displaced distal radial fractures treated with a volar locking plate with the results of such fractures treated with a conventional method of closed reduction and percutaneous wire fixation with supplemental bridging external fixation when required. Our aim was to ascertain whether the use of a volar locking plate improves functional outcomes.
A single-center, pragmatic, randomized controlled trial was conducted in a tertiary care institution. One hundred and thirty patients (eighteen to seventy-three years of age) who had a displaced distal radial fracture were randomized to treatment with either a volar locking plate (n = 66) or a conventional percutaneous fixation method (n = 64). Outcome assessments were conducted at six weeks, twelve weeks, and one year. Outcomes were measured on the basis of scores on the Patient Evaluation Measure (PEM) and QuickDASH questionnaire (a shortened version of the Disabilities of the Arm, Shoulder and Hand, or DASH, Outcome Measure), EuroQol-5D (EQ-5D) scores, wrist range of motion, grip strength, and radiographic parameters.
The rate of follow-up at one year was 95%. Patients in the volar locking-plate group had significantly better PEM and QuickDASH scores and range of motion at six weeks compared with patients in the conventional-treatment group, but there were no significant differences between the two groups at twelve weeks or one year. Grip strength was better in the plate group at all time points. The volar locking plate was better at restoring palmar tilt and radial height. Significantly more patients in the plate group were driving at the end of six weeks, but this did not translate to a significant difference between groups in terms of those returning to work by that time.
Use of a volar locking plate resulted in a faster early recovery of function compared with use of conventional methods. However, no functional advantage was demonstrated at or beyond twelve weeks. Use of the volar locking plate resulted in better anatomical reduction and grip strength, but there was no significant difference in function between the groups at twelve weeks or one year. The earlier recovery of function may be of advantage to some patients.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在比较掌侧锁定板治疗桡骨远端移位骨折的结果与传统闭合复位经皮钢丝固定加补充桥接外固定治疗桡骨远端骨折的结果。我们旨在确定使用掌侧锁定板是否能改善功能结果。
在一家三级护理机构进行了一项单中心、实用、随机对照试验。将 130 名（18 至 73 岁）桡骨远端移位骨折患者随机分为掌侧锁定板治疗组（n=66）和传统经皮固定组（n=64）。在 6 周、12 周和 1 年进行结局评估。采用患者评估量表（PEM）和快速残疾评定量表（QuickDASH）问卷（手臂、肩和手残疾量表，或 DASH，结局量表的简化版）、欧洲五维健康量表（EQ-5D）评分、腕关节活动度、握力和影像学参数来衡量结局。
1 年随访率为 95%。与传统治疗组相比，掌侧锁定板组在 6 周时的 PEM 和 QuickDASH 评分以及活动范围明显更好，但在 12 周或 1 年时两组间无显著差异。在所有时间点，掌侧锁定板组的握力均较好。掌侧锁定板在恢复掌倾角和桡骨高度方面更好。在 6 周末，更多的锁定板组患者在开车，但到那时，两组患者返回工作的比例并没有显著差异。
与传统方法相比，掌侧锁定板的使用可使功能更早恢复，但在 12 周或更长时间内并未显示出功能优势。掌侧锁定板的使用可使解剖复位和握力更好，但在 12 周或 1 年时两组间的功能无显著差异。一些患者可能更早恢复功能。
治疗性 I 级。请参见作者说明，以获取完整的证据水平描述。
