Cha Soo Min, Shin Hyun Dae, Lee Soong Hyun
Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
Injury. 2018 Oct;49(10):1816-1821. doi: 10.1016/j.injury.2018.08.019. Epub 2018 Aug 22.
Weperformed a retrospective case-control study to explore the hypothesis that conditions adjacent to Lister's tubercle (LT) in patients with distal radial fractures (DRFs) exhibiting dorsal comminution would influence the extent of the delayed extensor pollicis longus (EPL) rupture.
Among patients treated by volar locking plates (VLPs) were placed between March 2011 and December 2015, 314 met inclusion/exclusion criteria and were analyzed. We designated group 1 as the "EPL rupture" and group 2 as the "no EPL rupture". Basic demographic data, radiological findings, and operative variables were evaluated. The fracture patterns around LT were classified as follows: type I, no fracture line/fragment in LT or the EPL groove (third compartment); type IIA, a fracture of LT or the EPL groove with displacement <2 mm; type IIB, a fracture of LT or the EPL groove with displacement >2 mm; and type III, the presence of an island-shaped fracture fragment of LT (isolated free fragment of LT).
EPL ruptures were found in 18 patients (5.7%). The basic demographic parameters did not differ significantly among the groups. Clinically, neither the time to surgery nor the type of VLP used (of three different types) was not significantly associated with EPL rupture, nor was arthroscopically assisted reduction. In terms of radiological variables, the overall ratio of intra-to-extra-articular fractures did not differ among the groups. However, the fracture type significantly affected the extent of the rupture (P < 0.001), the odds ratio of which increased significantly in the fracture order IIA, IIB, and III, compared to type I (91.9, 220.1, and 342.06, respectively).
The extent of delayed EPL rupture after treatment of DRFs by VLPs was associated with the fracture pattern around the LT. Especially, an island-shaped LT fracture was associated with a high rupture risk because callus formation narrowed the EPL groove.
Therapeutic Level III.
我们进行了一项回顾性病例对照研究，以探讨桡骨远端骨折（DRF）伴背侧粉碎的患者中，与李斯特结节（LT）相邻的情况是否会影响拇长伸肌（EPL）延迟性断裂的程度。
在2011年3月至2015年12月间接受掌侧锁定钢板（VLP）治疗的患者中，314例符合纳入/排除标准并进行分析。我们将第1组定为“EPL断裂”组，第2组定为“无EPL断裂”组。评估基本人口统计学数据、影像学表现和手术变量。LT周围的骨折类型分类如下：I型，LT或EPL沟（第三区）无骨折线/骨折块；IIA型，LT或EPL沟骨折，移位<2mm；IIB型，LT或EPL沟骨折，移位>2mm；III型，LT存在岛状骨折块（LT孤立游离骨折块）。
18例患者（5.7%）发生EPL断裂。各组间基本人口统计学参数无显著差异。临床上，手术时间、所用VLP类型（三种不同类型）以及关节镜辅助复位均与EPL断裂无显著相关性。在影像学变量方面，各组间关节内骨折与关节外骨折的总体比例无差异。然而，骨折类型显著影响断裂程度（P<0.001），与I型相比，IIA、IIB和III型骨折的优势比显著增加（分别为91.9、220.1和342.06）。
VLP治疗DRF后EPL延迟性断裂的程度与LT周围的骨折类型有关。特别是，岛状LT骨折与高断裂风险相关，因为骨痂形成使EPL沟变窄。
治疗性III级。
