Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Health Sciences, University of York, York, UK.
Bone Joint J. 2019 Aug;101-B(8):978-983. doi: 10.1302/0301-620X.101B8.BJJ-2018-1285.R1.
The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury.
We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture.
At 12 months, 402/448 participants (90%) recruited into the main study provided PRWE scores. At year two, 294 participants (66%) provided scores; at year five, 198 participants (44%) provided scores. There was no clinically relevant difference in the PRWE at any point during the five-year follow-up; at five years, the PRWE score was 8.3 (12.5) in the wire group and 11.3 (15.6) in the plate group (95% confidence interval -6.99 to 0.99; p = 0.139). Nor was there a clinically relevant difference in health-related quality of life. Only three participants had further surgery in the five years after their injury (one in the wire group and two in the plate group).
This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires locking plates in the five years following a dorsally displaced fracture of the distal radius. Cite this article: 2019;101-B:978-983.
本研究旨在比较克氏针（K-wire）固定与锁定板固定治疗桡骨远端背侧移位骨折患者在损伤后 5 年内的临床疗效。
我们报告了一项多中心、双臂、平行组随机对照试验的 5 年随访结果。共有 461 名来自英国 18 个创伤中心的桡骨远端背侧关节内 3cm 内骨折且需要手术固定的成年人患者入选。如果腕关节表面严重移位需要切开复位，则排除在外。共有 448 名患者随机接受克氏针固定或锁定板固定。在克氏针组中，有 179 名女性和 38 名男性患者，平均年龄为 59.1 岁（19 至 89 岁）。在锁定板组中，有 194 名女性和 37 名男性患者，平均年龄为 58.3 岁（20 至 89 岁）。主要结局测量指标为患者自评腕关节评估（PRWE）。次要结局指标包括使用 EuroQol 五维三水平（EQ-5D-3L）评估的健康相关生活质量，以及与指数骨折相关的进一步手术。
在 12 个月时，448 名主要研究参与者中有 402 名（90%）提供了 PRWE 评分。在第 2 年，有 294 名参与者（66%）提供了评分；在第 5 年，有 198 名参与者（44%）提供了评分。在五年随访期间，任何时候 PRWE 均无临床相关差异；在第 5 年，克氏针组的 PRWE 评分为 8.3（12.5），锁定板组为 11.3（15.6）（95%置信区间-6.99 至 0.99；p=0.139）。健康相关生活质量也没有临床相关差异。只有 3 名参与者在受伤后 5 年内再次接受手术（克氏针组 1 例，锁定板组 2 例）。
这项随访研究继续表明，在桡骨远端背侧移位骨折后 5 年内，用克氏针或锁定板治疗的患者在腕关节疼痛、腕关节功能或生活质量方面均无差异。
2019;101-B:978-983.
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