Seki Y, Aoki T, Maehara H, Shirasawa S
Department of Orthopedic Surgery, Suwa Central Hospital, 4300 3918503 Tamagawa, Chino, Nagano, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 6068501, Japan.
Hand Surg Rehabil. 2019 Feb;38(1):28-33. doi: 10.1016/j.hansur.2018.10.246. Epub 2018 Dec 1.
We compared post-operative distal radius fracture (DRF) displacement after volar locking plate fixation using full-length unicortical and shorter-length distal locking screws. In this non-inferiority, retrospective cohort study, DRFs treated with volar locking plate fixation were evaluated on X-rays. In the full-length group, volar locking plate fixation was performed with full-length unicortical distal locking screws. In the shorter-length group, the distal locking screws were planned pre-operatively to be approximately 75% of the distal radius depth based on the lunate depth, and the same depth was drilled. Three radiographic parameters - ulnar variance, volar tilt, and radial inclination - were measured intra-operatively and at the final follow-up. The displacements were compared between the two groups. Each group contained 34 fractures. The mean ulnar variance between the two periods increased 1.1 mm in the full-length group and 1.3 mm in the shorter group (mean difference, 0.2 mm; 90% confidence interval, -0.3 to 0.6). The shorter group was not significantly inferior to the full-length one. Volar tilt increased 0.6° in the full-length group and -0.1° in the shorter group, while the radial inclination increased 0.1° in the full-length group and 0.2° in the shorter one. The differences in the increases were not significant. The post-operative DRF stability of 75%-length distal locking screws was not inferior to that of full-length unicortical screws. To prevent extensor pollicis longus tendon rupture, shorter distal locking screws and the same drilling depth may be preferable for volar locking plate fixation.
我们比较了使用全长单皮质和较短长度的远端锁定螺钉进行掌侧锁定钢板固定术后桡骨远端骨折（DRF）的移位情况。在这项非劣效性回顾性队列研究中，对接受掌侧锁定钢板固定治疗的DRF进行了X线评估。在全长组中，使用全长单皮质远端锁定螺钉进行掌侧锁定钢板固定。在较短长度组中，术前根据月骨深度将远端锁定螺钉规划为桡骨远端深度的约75%，并钻出相同深度。术中及末次随访时测量了三个影像学参数——尺骨变异、掌倾角和桡骨倾斜角。比较了两组之间的移位情况。每组包含34例骨折。两个时期之间的平均尺骨变异在全长组增加了1.1mm，在较短组增加了1.3mm（平均差异为0.2mm；90%置信区间为-0.3至0.6）。较短组并不显著劣于全长组。掌倾角在全长组增加了0.6°，在较短组增加了-0.1°，而桡骨倾斜角在全长组增加了0.1°，在较短组增加了0.2°。增加量的差异不显著。75%长度的远端锁定螺钉术后DRF稳定性不劣于全长单皮质螺钉。为防止拇长伸肌腱断裂，对于掌侧锁定钢板固定，较短的远端锁定螺钉和相同的钻孔深度可能更可取。
