1Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
J Bone Joint Surg Am. 2017 Aug 2;99(15):1261-1273. doi: 10.2106/JBJS.16.00773.
BACKGROUND: The aim of this single-center, single-blinded, prospective randomized trial was to compare the outcomes of tension-band wire (TBW) and plate fixation for simple isolated, displaced fractures of the olecranon. METHODS: We performed a prospective randomized trial involving 67 patients who were ≥16 to <75 years of age and had an acute isolated, displaced fracture of the olecranon. Patients were randomized to either TBW (n = 34) or plate fixation (n = 33) and were evaluated at 6 weeks, 3 months, 6 months, and 1 year following surgery. The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year. RESULTS: The baseline demographic and fracture characteristics of the 2 groups were comparable, except for age, which was lower in the TBW group. The 1-year follow-up rate was 85% (n = 57), with 84% (n = 56) completing the DASH. There was a significant improvement in the DASH score over the 1-year period following surgery (p < 0.001). At 1 year, the DASH score for the TBW group (12.8) did not differ significantly from that of the plate group (8.5) (p = 0.315). The groups also did not differ significantly in terms of range of motion, the Broberg and Morrey score, the Mayo Elbow Score, or the DASH at all assessment points over the 1 year (all p ≥ 0.05). Complication rates were significantly higher in the TBW group (63% compared with 38%; p = 0.042), predominantly because of a significantly higher rate of metalwork removal in symptomatic patients (50.0% compared with 22%; p = 0.021). Four infections occurred, all in the plate group (0% versus 13%; p = 0.114), as did 3 revision surgeries (0% versus 9.4%; p = 0.238). CONCLUSIONS: Among active patients with a simple isolated, displaced fracture of the olecranon, no difference was found between TBW and plate fixation in the patient-reported outcome at 1 year following surgery. The complication rate was higher following TBW fixation and was due to a higher rate of implant removal in symptomatic patients. However, the more serious complications of infection and the need for revision surgery occurred exclusively following plate fixation in this trial. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景：本单中心、单盲、前瞻性随机试验旨在比较张力带钢丝（TBW）和钢板固定治疗单纯性、移位性尺骨鹰嘴骨折的疗效。
方法：我们进行了一项前瞻性随机试验，纳入了 67 名年龄在 16 岁至 75 岁之间、急性单纯性、移位性尺骨鹰嘴骨折的患者。患者被随机分为 TBW 组（n=34）或钢板固定组（n=33），并在术后 6 周、3 个月、6 个月和 1 年进行评估。主要结局指标为术后 1 年时的手臂、肩部和手部残疾（DASH）评分。
结果：两组的基线人口统计学和骨折特征相当，除了年龄，TBW 组的年龄较低。1 年随访率为 85%（n=57），84%（n=56）完成了 DASH 评分。术后 1 年内 DASH 评分显著改善（p<0.001）。术后 1 年时，TBW 组（12.8）的 DASH 评分与钢板组（8.5）无显著差异（p=0.315）。两组在 1 年内的活动范围、Broberg 和 Morrey 评分、梅奥肘评分或 DASH 评分均无显著差异（均 p≥0.05）。TBW 组的并发症发生率明显高于钢板组（63%比 38%；p=0.042），主要是由于有症状患者的金属去除率明显较高（50.0%比 22%；p=0.021）。共发生 4 例感染，均在钢板组（0%比 13%；p=0.114），3 例翻修手术（0%比 9.4%；p=0.238）。
结论：在活动患者中，对于单纯性、移位性尺骨鹰嘴骨折，TBW 和钢板固定在术后 1 年的患者报告结局方面无差异。TBW 固定的并发症发生率较高，原因是有症状患者的植入物去除率较高。然而，在本试验中，仅在钢板固定组发生了更严重的并发症感染和需要翻修手术。
证据水平：治疗性 1 级。请参阅作者指南，以获取完整的证据水平描述。
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