Roh Young Hak, Lee Beom Koo, Baek Jong Ryoon, Noh Jung Ho, Gong Hyun Sik, Baek Goo Hyun
Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Hand Surg Am. 2015 Jan;40(1):34-41. doi: 10.1016/j.jhsa.2014.09.025. Epub 2014 Oct 29.
To compare surgical outcomes of volar locking plates (VP) and external fixation (EF) (with or without intra-focal fixation) for AO-type C2 and C3 fractures of the distal radius.
From an initial group of 92 patients with AO-type C2 and C3 distal radius fractures who were enrolled in a prospective, randomized study comparing volar plate fixation with external fixation (with or without intra-focal fixation), 74 patients were studied. The researchers evaluated functional assessments (wrist range of motion, grip strength, and Michigan Hand Questionnaire) at each patient visit and measured radiographic assessment (radial inclination, volar tilt, ulnar variance, and articular congruity) at 12 months.
The grip strength of the VP group was significantly greater than that of the EF group at 3 and 6 months. The range of motion was significantly greater in the VP group than in the EF group at 3 months. There were no significant differences in the range of motion and grip strength between the 2 groups at 12 months. The Michigan Hand Questionnaire score was higher in the VP group than in the EF group at 3 months but was same at 12 months. There was no significant difference between groups with respect to volar tilt or radial inclination. The VP group showed superior radiologic outcomes in terms of the ulnar variance. One patient in the VP group and 3 in the EF group had an intra-articular stepoff deformity greater than 2 mm. This difference did not reach statistical significance.
These results for functional recovery after distal radius surgery offer insight into treatment decisions and interpretations of treatment outcomes for patients with comminuted intra-articular distal radius fractures.
比较掌侧锁定钢板（VP）与外固定（EF，有或无病灶内固定）治疗桡骨远端AO C2型和C3型骨折的手术疗效。
在一项比较掌侧钢板固定与外固定（有或无病灶内固定）的前瞻性随机研究中，最初纳入了92例桡骨远端AO C2型和C3型骨折患者，对其中74例患者进行研究。研究人员在每次患者就诊时评估功能指标（腕关节活动范围、握力和密歇根手功能问卷），并在12个月时测量影像学指标（桡骨倾斜度、掌倾角、尺骨变异和关节面平整度）。
VP组在3个月和6个月时的握力显著大于EF组。VP组在3个月时的活动范围显著大于EF组。两组在12个月时的活动范围和握力无显著差异。VP组在3个月时的密歇根手功能问卷评分高于EF组，但在12个月时相同。两组在掌倾角或桡骨倾斜度方面无显著差异。VP组在尺骨变异方面显示出更好的影像学结果。VP组有1例患者和EF组有3例患者出现大于2 mm的关节内台阶样畸形。这种差异未达到统计学意义。
桡骨远端手术后功能恢复的这些结果为粉碎性关节内桡骨远端骨折患者的治疗决策和治疗结果解读提供了参考。
