Bae Joo-Yul, Yoon Jun O, Choi Shin Woo, Kim Jae Kwang
Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, South Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Orthop Sci. 2017 Nov;22(6):1049-1053. doi: 10.1016/j.jos.2017.08.007. Epub 2017 Aug 21.
The purpose of this study was to determine whether a partially healed (surgical delay of 2-6 weeks) metaphyseally malaligned distal radius fracture (DRF) treated using the extended palmar approach with palmar locking plate fixation has poorer clinical or radiological outcomes than those of acute (surgical delay of ≤2 weeks) metaphyseally unstable DRF treated by palmar locking plate fixation.
We identified 24 patients (Group A) who were treated with palmar locking plate for a partially healed (surgical delay of 2-6 weeks) metaphyseally malaligned DRF. We selected 48 patients (Group B) who were treated with palmar locking plate among the acute (surgical delay of ≤2 weeks) metaphyseally unstable DRF to be individually matched in a 1:2 ratio for sex, age, and fracture type. The two study groups were compared with respect to clinical and radiological parameters. The clinical parameters examined were; wrist range of motion (flexion, extension, supination, and pronation), grip strength, and Disabilities of Arm, Shoulder and Hand (DASH) scores. Radiological measurements included radial inclination, palmar angulation, and ulnar variance.
The wrist flexion and grip strength were significantly greater in group B than group A at 3 months postoperatively. However, wrist ranges of motion, grip strengths, and DASH scores were not significantly different at 1 year postoperatively. Radiographic evaluation demonstrated no intergroup difference in terms of radial inclination, palmar angulation, or ulnar variance at 1 year postoperatively.
Partially healed metaphyseally malaligned healed DRFs had inferior clinical outcomes to acute metaphyseally unstable DRFs in an early postoperative period, however, achieved similar clinical outcomes at 1 year postoperatively when treated using palmar locking plate fixation.
本研究的目的是确定采用延长掌侧入路及掌侧锁定钢板固定治疗的部分愈合（手术延迟2 - 6周）的桡骨远端干骺端对线不良骨折（DRF），其临床或影像学结果是否比采用掌侧锁定钢板固定治疗的急性（手术延迟≤2周）干骺端不稳定DRF更差。
我们纳入了24例采用掌侧锁定钢板治疗部分愈合（手术延迟2 - 6周）的桡骨远端干骺端对线不良骨折的患者（A组）。我们选取了48例采用掌侧锁定钢板治疗急性（手术延迟≤2周）干骺端不稳定DRF的患者（B组），按照性别、年龄和骨折类型以1:2的比例进行个体匹配。比较两组的临床和影像学参数。检查的临床参数包括：腕关节活动范围（屈曲、伸展、旋后和旋前）、握力以及上肢、肩部和手部功能障碍（DASH）评分。影像学测量包括桡骨倾斜度、掌侧成角和尺骨变异。
术后3个月时，B组的腕关节屈曲和握力明显大于A组。然而，术后1年时，两组的腕关节活动范围、握力和DASH评分无显著差异。影像学评估显示术后1年时，两组在桡骨倾斜度、掌侧成角或尺骨变异方面无组间差异。
部分愈合的桡骨远端干骺端对线不良骨折在术后早期的临床结果比急性干骺端不稳定骨折差，然而，采用掌侧锁定钢板固定治疗时，术后1年时临床结果相似。
