两种三分之二远端尺骨干骨折固定方法的成人比较研究，随访至少 2 年。

A comparative study of fixation methods in adults with two-thirds distal isolated ulnar shaft fractures with a minimum of 2 year follow-up.

机构信息

Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France.

出版信息

Injury. 2020 Apr;51(4):964-970. doi: 10.1016/j.injury.2020.02.085. Epub 2020 Feb 18.

DOI:10.1016/j.injury.2020.02.085

PMID:32093940

Abstract

BACKGROUND

Adult isolated ulnar shaft fractures (IUSF) are rare. There remains a need to establish the best methods to manage these fractures. The aim of this study was to compare two forms of treatment for IUSF: intramedullary stabilization by k-wire (IMF) versus Open Reduction Internal Fixation by plating (ORIF), in order to identify differences in clinical (1) and radiological outcomes (2), as well as comparative costs (3).

HYPOTHESIS

The hypothesis of this study was assessing whether intramedullary stabilization was as feasible as plating in the treatment of isolated ulnar shaft fractures in clinical practice.

PATIENTS AND METHODS

A retrospective analysis was undertaken on patients diagnosed IUSF between January 2015 and March 2017 with a minimum of 2 years follow-up. They were treated with IMF (group 1) or ORIF (group 2). Demographic information, clinical outcomes and complications were collected. Cost, including implant cost, operative time, sterilization and inpatient stay were compared. Radiographs were reviewed to evaluate axial angulation, shortening, displacement and residual deformity.

RESULTS

54 patients with a mean age of 41.2 years were treated by IMF (27/54) and ORIF (27/54). The mechanism of injury included high-energy (55%) and low-energy falls (45%). AO/OTA 2018 fracture classification was simple (39/54), wedge (14/54) and complex (1/54). The locations were 37/54 (70%) distal third and 17/54 (30%) mid-shaft fractures. There was no significant difference pre and post-operatively between the 2 groups regarding radiologic criteria. 3 cases of non-union, 4 delay-union and 1 regional complex syndrome occurred in group 2. No complication was reported in group 1. The function determined by range of motion (ROM) at wrist and elbow was excellent in 72% (group 1) and 80% (group2), 18% satisfactory in group 1 and 20% in group 2. There was no difference for QuickDASH and pain. Implant removal was necessary in 70% of patients without sequelae in nailing, 11% after plating. Average operation time was 29 ± 5 min for ORIF and 18 ± 6 min for IMF. Total estimated cost per patient was 3678.4€ for IMF and 7051.9€ for ORIF.

CONCLUSIONS

Compared with ORIF, IMF significantly reduced the operation time and cost with lower complications.

TYPE OF STUDY

Retrospective study.

TYPE OF PROOF

Level 4.

摘要

背景

成人尺骨干骨折（IUSF）较为少见。目前仍需确定治疗此类骨折的最佳方法。本研究旨在比较两种治疗尺骨干骨折的方法：克氏针髓内固定（IMF）与钢板切开复位内固定（ORIF），以确定在临床（1）和影像学结果（2）方面的差异，以及比较成本（3）。

假设

本研究的假设是评估在临床实践中，尺骨干骨折的髓内固定是否与钢板固定一样可行。

患者和方法

对 2015 年 1 月至 2017 年 3 月期间诊断为 IUSF 的患者进行回顾性分析，随访时间至少为 2 年。他们分别接受 IMF（组 1）或 ORIF（组 2）治疗。收集人口统计学信息、临床结果和并发症。比较成本，包括植入物成本、手术时间、消毒和住院时间。评估 X 线片评估轴向成角、缩短、移位和残余畸形。

结果

54 例患者平均年龄为 41.2 岁，接受 IMF（27/54）和 ORIF（27/54）治疗。损伤机制包括高能（55%）和低能跌倒（45%）。AO/OTA 2018 骨折分类为简单（39/54）、楔形（14/54）和复杂（1/54）。位置为 37/54（70%）在远端三分之一和 17/54（30%）在中段。两组患者术前和术后影像学标准均无显著差异。组 2 中发生 3 例骨不连、4 例延迟愈合和 1 例区域性复杂综合征。组 1 无并发症报告。通过腕关节和肘关节的活动范围（ROM）确定的功能在组 1 中为 72%（组 1）和 80%（组 2），在组 1 中为 18%满意，在组 2 中为 20%满意。QuickDASH 和疼痛无差异。组 1 中有 70%的患者需要取出内固定，无后遗症，组 2 中有 11%需要取出内固定。ORIF 的平均手术时间为 29±5 分钟，IMF 为 18±6 分钟。每组患者的总估计费用分别为 3678.4 欧元和 7051.9 欧元。