Landgren Marcus, Abramo Antonio, Geijer Mats, Kopylov Philippe, Tägil Magnus
a Department of Orthopedics , Clinical Sciences, Lund University and Skåne University Hospital , Lund.
b Department of Hand Surgery Malmö , Skåne University Hospital , Malmö.
Acta Orthop. 2017 Aug;88(4):451-456. doi: 10.1080/17453674.2017.1303601. Epub 2017 Mar 14.
Background and purpose - During the last decades, treatment of distal radius fractures (DRFs) has changed, with surgical intervention being more common and with new techniques. We investigated whether this change has influenced the subjective outcome. Here we report, year by year, the 1-year score after a DRF over a 10-year-period, using a patient-reported outcome measure. Patients and methods - Patients aged 18 years or more with a DRF between 2003 and 2012 were prospectively and consecutively registered in a longitudinal outcome database. 1 year after the fracture, all the patients were sent a validated subjective outcome questionnaire, the Disabilities of the Arm, Shoulder, and Hand (DASH). The lower the score (0-100), the better the outcome. Results - Between 2003 and 2012, 3,666 patients (2,833 of them women; mean age 62 (18-98) years) were included. 22% were operated and the rate remained constant over the years. The surgical methods shifted from external fixators (42%) and fragment-specific plates (45%) in 2003, to mainly volar locking plates (65%) in 2012. 70% of the patients responded to the 1-year DASH questionnaire. The median DASH score was 9 (IQR: 2-25) for the cohort, both in surgically treated patients (9 (IQR: 3-25)) and in non-surgically treated patients (9 (IQR 2-27)). Subgroup analysis showed a higher median DASH score for women than for men; for patients with AO type C fractures rather than type B or type A fractures; for patients with external fixation or fragment-specific fixation than for those who underwent surgery using volar locking plates; and for patients who were operated by a general orthopedic surgeon rather than a hand surgeon. Interpretation - The shift in surgical treatment had no influence on the subjective outcome for the cohort.
背景与目的——在过去几十年间,桡骨远端骨折(DRF)的治疗方式发生了变化,手术干预更为常见且出现了新技术。我们研究了这种变化是否影响主观预后。在此,我们逐年报告10年间DRF患者1年的评分情况,采用患者报告的预后指标。
患者与方法——2003年至2012年间年龄在18岁及以上的DRF患者被前瞻性地连续纳入一个纵向预后数据库。骨折后1年,向所有患者发送一份经过验证的主观预后问卷,即上肢、肩部和手部功能障碍(DASH)问卷。分数越低(0 - 100分),预后越好。
结果——2003年至2012年间,共纳入3666例患者(其中2833例为女性;平均年龄62(18 - 98)岁)。22%的患者接受了手术治疗,且多年来该比例保持不变。手术方法从2003年的外固定架(42%)和碎骨块特定钢板(45%),转变为2012年主要采用掌侧锁定钢板(65%)。70%的患者对1年的DASH问卷做出了回应。该队列患者的DASH评分中位数为9(四分位间距:2 - 25),手术治疗患者(9(四分位间距:3 - 25))和非手术治疗患者(9(四分位间距2 - 27))均如此。亚组分析显示,女性的DASH评分中位数高于男性;AO C型骨折患者高于B型或A型骨折患者;接受外固定或碎骨块特定固定的患者高于接受掌侧锁定钢板手术的患者;由普通骨科医生而非手外科医生进行手术的患者评分较高。
解读——手术治疗方式的转变对该队列患者的主观预后没有影响。