Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
Rheumatic Disease Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
J Bone Joint Surg Am. 2014 Sep 3;96(17):1451-9. doi: 10.2106/JBJS.M.00268.
Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture.
A total of 336 adult patients with an acute fracture of the distal aspect of the radius were recruited over a one-year period and randomized to receive 500 mg of vitamin C or placebo daily for fifty days after the fracture. The primary outcomes were the DASH (Disabilities of the Arm, Shoulder and Hand) score at six weeks and at one year. Secondary variables included complications, wrist and finger motion, grip and pinch strength, pain, and a CRPS score.
There were no significant differences in patient or fracture characteristics between the treatment groups. There was no significant effect of vitamin C on the DASH score throughout the study period. At six weeks, patients in the vitamin C group with a nondisplaced fracture had a significantly greater wrist flexion deficit (p = 0.008) and pinch strength deficit (p = 0.020) and a greater rate of CRPS (p = 0.022), but there was no difference in the CRPS rate at any other time point. At twenty-six weeks, there was a higher rate of complications (p = 0.043) and greater pain with use (p = 0.045) in the patients with a displaced fracture treated with vitamin C. There was no significant difference in the time to fracture-healing.
This study demonstrated no significant difference at one year in the DASH score, other functional outcomes, the rate of CRPS, or osseous healing of nondisplaced or displaced distal radial fractures treated with vitamin C compared with placebo. We conclude that administration of vitamin C confers no benefit to patients with a displaced or nondisplaced fracture of the distal aspect of the radius.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
维生素 C 被提议通过促进骨和软组织愈合以及降低复杂性区域疼痛综合征 (CRPS) 的患病率来改善桡骨远端骨折的预后。我们的主要目的是研究维生素 C 对桡骨远端骨折后功能结果的影响。
在一年的时间内，共招募了 336 名成人桡骨远端急性骨折患者，并随机分为两组，分别在骨折后 50 天内每天接受 500 毫克维生素 C 或安慰剂治疗。主要结局是 6 周和 1 年时的 DASH（手臂、肩部和手的残疾）评分。次要变量包括并发症、腕部和手指运动、握力和捏力、疼痛以及 CRPS 评分。
治疗组患者和骨折特征无显著差异。在整个研究期间，维生素 C 对 DASH 评分没有显著影响。在 6 周时，维生素 C 组无移位骨折患者的腕关节屈曲缺陷（p = 0.008）和捏力缺陷（p = 0.020）更大，CRPS 发生率更高（p = 0.022），但在其他任何时间点 CRPS 发生率无差异。在 26 周时，维生素 C 治疗的移位骨折患者并发症发生率更高（p = 0.043），使用时疼痛更严重（p = 0.045）。骨折愈合时间无显著差异。
与安慰剂相比，维生素 C 治疗无移位或移位的桡骨远端骨折在 1 年时 DASH 评分、其他功能结局、CRPS 发生率或骨愈合方面没有显著差异。我们得出结论，给予维生素 C 对无移位或移位的桡骨远端骨折患者没有益处。
治疗 II 级。有关证据水平的完整描述，请参见作者说明。
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