Department of Orthopedics, Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Physiotherapy, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Plast Surg Hand Surg. 2020 Apr;54(2):94-100. doi: 10.1080/2000656X.2019.1693392. Epub 2019 Nov 23.
The aim was to investigate the long-term outcome after corrective osteotomy for malunion of distal radius fractures. Radiological findings, function, activity performance, pain, health-related quality of life and self-efficacy were studied. Evaluation of 37 patients 3-10 years after osteotomy fixated with a volar plate. Conventional radiographs were taken. Grip strength and range of motion were evaluated. Scores from the Patient Rated Wrist Evaluation (PRWE) were compared with normative values. The RAND-36 was used for evaluation of health-related quality of life and the General Self-Efficacy scale (S-GSE) for self-efficacy. Radial height, volar tilt, and ulnar variance improved postoperatively. In the long term, the corrections were maintained. Radiographs showed significantly more advanced osteoarthritis. Mean grip strength was 31 kg (SD 13) 89%, and range of motion varied between 80% and 95% compared to the uninjured side. The median PRWE was 12 points (0-99). The study group experienced higher levels of pain than reference values. There was a moderate correlation between the PRWE and volar tilt (rs = 0.453, = .006) and grip strength (rs = 0.40, = .014). At long-term follow-up functional outcome after a corrective osteotomy is generally good, but patients may experience some degree of pain. Corrective osteotomy might be considered for patients with a poor functional outcome after a distal radius fracture.
目的在于研究桡骨远端骨折畸形愈合行矫正性截骨术后的长期疗效。研究评估了 37 例患者术后 3-10 年的影像学结果、功能、活动表现、疼痛、健康相关生活质量和自我效能。所有患者均采用掌侧钢板固定行矫正性截骨术。拍摄常规 X 线片,评估握力和关节活动度,将患者腕关节评分(PRWE)与正常值进行比较。采用 RAND-36 评估健康相关生活质量,采用一般自我效能感量表(S-GSE)评估自我效能。术后桡骨高度、掌倾角和尺骨变异均得到改善,且长期随访时矫正角度得以维持。X 线片显示存在更严重的骨关节炎。平均握力为 31kg(标准差 13),占健侧的 89%,活动度为 80%-95%。PRWE 中位数为 12 分(0-99 分)。研究组疼痛程度高于参考值。PRWE 与掌倾角(rs=0.453,P=0.006)和握力(rs=0.40,P=0.014)呈中度相关。矫正性截骨术后长期随访时,功能结局通常良好,但患者可能存在一定程度的疼痛。对于桡骨远端骨折后功能结局较差的患者,可以考虑行矫正性截骨术。