Martinez-Mendez Daniel, Lizaur-Utrilla Alejandro, de-Juan-Herrero Joaquin
1 Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain.
2 Faculty of Health Sciences, University of Alicante, Alicante, Spain.
J Hand Surg Eur Vol. 2018 Feb;43(2):142-147. doi: 10.1177/1753193417727139. Epub 2017 Sep 4.
We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures.
I.
我们比较了采用闭合复位及石膏固定或切开复位掌侧钢板内固定治疗的老年桡骨远端关节内骨折患者的治疗结果。97例60岁以上患者被随机分为保守治疗组（47例）和手术治疗组（50例）。在2年的时间里，我们评估了患者自评的腕关节评估评分、DASH（上肢、肩部和手部功能障碍）问卷、疼痛、腕关节活动范围、握力和放射学参数。与保守治疗相比，掌侧钢板固定后的功能结果和生活质量明显更好。我们发现关节面的恢复、桡骨倾斜度和尺骨变异影响治疗结果，但关节台阶移位不影响。25%的保守治疗患者出现复位的二次丢失。我们得出结论，对于老年桡骨远端关节内骨折患者，手术钢板固定比保守治疗能带来更好的治疗结果。
I级。
