掌侧锁定钢板与髓内钉治疗桡骨远端不稳定骨折的随机对照研究
Randomized comparison of volar locking plates and intramedullary nails for unstable distal radius fractures.
作者信息
Plate Johannes F, Gaffney Daniel L, Emory Cynthia L, Mannava Sandeep, Smith Beth P, Koman L Andrew, Wiesler Ethan R, Li Zhongyu
机构信息
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
出版信息
J Hand Surg Am. 2015 Jun;40(6):1095-101. doi: 10.1016/j.jhsa.2015.02.014. Epub 2015 Mar 31.
PURPOSE
To compare minimally invasive intramedullary nails (IMN) and volar locking plates (VLP) for the treatment of unstable distal radius fractures by evaluating postoperative subjective, radiographic, and functional outcomes. The hypothesis was that IMN patients would have less pain and required less pain medication in the early postoperative period and returned to work earlier than VLP patients.
METHODS
Sixty patients with closed, displaced, unstable, extra-articular, metaphyseal fractures of the distal radius were randomized to receive a VLP or an IMN for internal fixation. Functional outcomes (Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Questionnaire), radiographic measurements (ulnar variance, radial height, inclination, and volar tilt), and range of motion were assessed until final follow-up at 2 years after surgery. Narcotic pain medication use was documented for 5 weeks following surgery.
RESULTS
There were 2 groups of 30 patients with IMN (mean age, 55 ± 14 y) or VLP (mean age, 55 ± 16 y) with similar demographics and comorbidities. Patients with IMN regained extension earlier but had similar range of motion to patients with VLP at final follow-up. There was similar improvement in Michigan Hand Questionnaire, Quick Disabilities of the Arm, Shoulder, and Hand, and strength between groups. Five weeks after surgery, fewer IMN patients required narcotic pain medication (13%) than VLP patients (33%). Radiographic outcomes were similar at final follow-up. There were 3 failures with IMN versus 1 failure with VLP. All 10 employed patients with IMN returned to previous work compared with 10 of the 12 employed patients with VLP. Time to return to work was similar for both groups.
CONCLUSIONS
In a cohort of similar patients, IMN and VLP provided comparable improvement in functional and radiographic outcomes. Patients with IMN required less narcotic pain medication after surgery than VLP patients.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
目的
通过评估术后主观、影像学和功能结果，比较微创髓内钉（IMN）和掌侧锁定钢板（VLP）治疗不稳定桡骨远端骨折的效果。假设是IMN患者在术后早期疼痛较轻，所需止痛药物较少，且比VLP患者更早恢复工作。
方法
60例闭合性、移位、不稳定、关节外、干骺端桡骨远端骨折患者被随机分为接受VLP或IMN内固定治疗。评估功能结果（手臂、肩部和手部快速残疾评估、密歇根手功能问卷）、影像学测量（尺骨变异、桡骨高度、倾斜度和掌倾角）以及活动范围，直至术后2年的最终随访。记录术后5周内使用麻醉性止痛药物的情况。
结果
两组各30例患者，IMN组（平均年龄55±14岁）和VLP组（平均年龄55±16岁），人口统计学和合并症相似。IMN组患者更早恢复伸展，但在最终随访时与VLP组患者的活动范围相似。两组在密歇根手功能问卷、手臂、肩部和手部快速残疾评估以及力量方面的改善相似。术后5周，需要麻醉性止痛药物的IMN组患者（13%）少于VLP组患者（33%）。最终随访时影像学结果相似。IMN组有3例失败，VLP组有1例失败。所有10例就业的IMN患者均恢复了之前的工作，而12例就业的VLP患者中有10例恢复工作。两组恢复工作的时间相似。
结论
在一组相似患者中，IMN和VLP在功能和影像学结果方面提供了相当的改善。IMN患者术后所需麻醉性止痛药物比VLP患者少。
研究类型/证据水平：治疗性II级。
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