Mulders Marjolein A M, Detering Robin, Rikli Daniel A, Rosenwasser Melvin P, Goslings J Carel, Schep Niels W L
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam.
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam.
J Hand Surg Am. 2018 Aug;43(8):710-719.e5. doi: 10.1016/j.jhsa.2018.05.003. Epub 2018 Jun 13.
To evaluate the association between alignment, as determined by plain radiographs, and patient-reported outcome in adults with a displaced distal radius fracture. We also determined which specific radiological parameters are associated with patient-reported outcomes.
We performed a systematic literature search to identify studies that evaluated the association between radiological and patient-reported outcome in adults with a displaced distal radius fracture and who had an average follow-up of at least 12 months. Radiological outcome was determined as acceptable or unacceptable reduction, defined by radiological parameters. Patient-reported outcome was assessed with the Disability of the Arm, Shoulder, and Hand, the Quick-Disability of the Arm, Shoulder, and Hand, and the Patient-Rated Wrist Evaluation questionnaires.
Sixteen articles were included, comprising 1,961 patients with a distal radius fracture. A significant mean difference of 4.15 points in patient-reported outcomes (95% confidence interval [CI], 0.26-8.04) was found in favor of an acceptable radiological reduction. Moreover, a significant mean difference of 5.38 points in patient-reported outcomes (95% CI, 1.69-9.07) was found in favor of an acceptable dorsal angulation, and 6.72 points (95% CI, 2.16-11.29) in favor of an acceptable ulnar variance.
An unacceptable radiological reduction is significantly associated with worse patient-reported outcomes in adults with a displaced distal radius fracture. Dorsal angulation and ulnar variance are the most important radiological parameters. Despite the statistical significance, the mean difference of each association did not meet the threshold of the minimally clinically important difference and therefore were unlikely to be clinically important.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
通过X线平片确定的对线情况，评估桡骨远端骨折移位成人患者的对线与患者报告结局之间的关联。我们还确定了哪些特定的放射学参数与患者报告结局相关。
我们进行了系统的文献检索，以确定评估桡骨远端骨折移位成人患者放射学与患者报告结局之间关联且平均随访至少12个月的研究。放射学结局根据放射学参数确定为可接受或不可接受的复位。使用手臂、肩部和手部功能障碍量表、手臂、肩部和手部快速功能障碍量表以及患者自评腕关节评估问卷评估患者报告结局。
纳入16篇文章，共1961例桡骨远端骨折患者。发现患者报告结局存在显著平均差异4.15分（95%置信区间[CI]，0.26 - 8.04），支持可接受的放射学复位。此外，发现患者报告结局存在显著平均差异5.38分（95%CI，1.69 - 9.07），支持可接受的背侧成角，以及6.72分（95%CI，2.16 - 11.29），支持可接受的尺骨变异。
在桡骨远端骨折移位成人患者中，不可接受的放射学复位与较差的患者报告结局显著相关。背侧成角和尺骨变异是最重要的放射学参数。尽管具有统计学意义，但各关联的平均差异未达到最小临床重要差异的阈值，因此在临床上可能不重要。
研究类型/证据水平：预后性IV级。
