Gologan Renata E, Koeck M, Suda A J, Obertacke U
Klinik für Orthopädie Und Unfallchirurgie, Diakonissenkrankenhaus Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Speyerer Str. 91-93, 68163, Mannheim, Germany.
Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany.
Arch Orthop Trauma Surg. 2019 Jun;139(6):877-881. doi: 10.1007/s00402-019-03186-8. Epub 2019 Apr 10.
To clarify the role of concomitant carpal lesions in dislocated distal radius fractures (DRF), 104 consecutive patients with DRF underwent a preoperative morphological examination using CT and MRI. The study was performed between 2004 and 2006 with the aim of recording all types of concomitant carpal lesions as well as their consequences after 1 year. Carpal lesions of different types were found in all treated cases of dislocated DRF. A clinical follow-up 1 year (13.9 ± 6.5 months) after surgical treatment showed no correlation between the carpal lesions and the treatment outcome (previously described by Gologan et al. 2011). A second follow-up study ( > 10 years postoperative, range 11.2 ± 0.9 years) was initiated to find suspected later decompensations of the concomitant carpal lesions. A total of 37 of the original 104 patients could potentially be followed up: 22 patients had passed through both follow-ups and 15 could only be contacted with restrictions. 27 patients had died, 24 patients were excluded due to the presence of dementia or explicit rejection, and 16 patients could no longer be found. Using the Castaing score, the first follow-up after 1 year resulted in an average of 4.95 ± 3.1 points (range 0-12; "good result") and the second follow-up after 10 years in an average of 5.91 ± 2.9 points (range 2-14; "good result"). Again, there were no correlations with the primarily recognized carpal lesions [comparable groups 22 vs 22 (identical patients in both follow-ups); lost to follow-up rate 15.4%]. These results suggest that concomitant carpal lesions are primarily prevalent and detectable in (nearly) all dislocated DRF cases. However, with the usual protection of the wrist and the carpus after surgical treatment of DRF, these lesions often do not decompensate or require treatment, even after 10 years.
为阐明合并腕部损伤在桡骨远端骨折脱位(DRF)中的作用,104例连续性DRF患者术前采用CT和MRI进行形态学检查。该研究于2004年至2006年进行,目的是记录所有类型的合并腕部损伤及其1年后的后果。在所有治疗的DRF脱位病例中均发现了不同类型的腕部损伤。手术治疗1年后(13.9±6.5个月)的临床随访显示,腕部损伤与治疗结果之间无相关性(Gologan等人于2011年曾描述过)。开展了第二项随访研究(术后>10年,范围为11.2±0.9年),以发现合并腕部损伤可能出现的后期失代偿情况。最初的104例患者中共有37例有可能接受随访:22例患者完成了两次随访,15例只能在有限条件下取得联系。27例患者死亡,24例因患有痴呆症或明确拒绝而被排除,16例患者无法再找到。使用卡斯廷评分,1年后的首次随访平均得分为4.95±3.1分(范围0 - 12;“良好结果”),10年后的第二次随访平均得分为5.91±2.9分(范围2 - 14;“良好结果”)。同样,与最初发现的腕部损伤无相关性[可比组22对22(两次随访中的同一患者);失访率15.4%]。这些结果表明,合并腕部损伤在(几乎)所有DRF脱位病例中主要普遍存在且可检测到。然而,在DRF手术治疗后对腕部和腕骨进行常规保护的情况下,即使在10年后,这些损伤通常也不会失代偿或需要治疗。