Li Dong, Liu Yu, Li Dongcheng, Tang Wen, Yin Qudong
Department of Radiology, Liyang People's Hospital, Liyang, Jiangsu 213000, P.R. China.
Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China.
Exp Ther Med. 2020 Mar;19(3):1871-1877. doi: 10.3892/etm.2020.8434. Epub 2020 Jan 8.
The present study aimed to classify double-column die-punch fractures of the distal radius according to imaging data, and to evaluate their clinical features. A retrospective analysis of imaging data derived from 498 patients diagnosed with a double-column die-punch fracture of the distal radius was performed. The fractures were divided into those with middle-column avulsion with fracture of the radial-column articular surface (type I), those with middle-column collapse with fracture of the radial-column articular surface (type II), those with middle-column collapse with fracture of epiphysis of the radial column (type III) or mixed-type fractures (type IV). The intra- and inter-observer consistency between assessors was analyzed with kappa statistics. The patients with double-column die-punch fractures of the distal radius were followed up. There were 21 cases of type I fracture, 135 cases of type II fracture, 130 cases of type III fracture and 212 cases of type IV fracture. The intra-observer kappa coefficient ranged from 0.810-0.861, whereas the inter-observer kappa coefficient range was 0.830-0.876, with high consistency. Following 13 months of follow-up, the patients were assessed for functional recovery of the wrist and hand using the Gartland-Werley scoring system. The analysis indicated that in 95.78% of the patients, wrist function was rated as excellent or good (n=477), while in 4.22% of patients it was rated as fair (n=21), mainly due to the development of post-traumatic arthritis of the wrist following inappropriate therapy. All of the cases were type IV and type III fractures. These data demonstrated the application of a novel classification system named the Three-Column Classification, used to classify double-column die-punch fractures of the distal radius. This method reflected the mechanisms and severity of the fractures, conforming to the principle of AO fracture classification. Furthermore, it exhibited high consistency and may provide reference values for clinical diagnosis, treatment and prognostic evaluation.
本研究旨在根据影像学数据对桡骨远端双柱冲压骨折进行分类，并评估其临床特征。对498例诊断为桡骨远端双柱冲压骨折患者的影像学数据进行回顾性分析。骨折分为桡骨柱关节面骨折伴中柱撕脱（I型）、桡骨柱关节面骨折伴中柱塌陷（II型）、桡骨柱骨骺骨折伴中柱塌陷（III型）或混合型骨折（IV型）。采用kappa统计分析评估者之间的观察者内和观察者间一致性。对桡骨远端双柱冲压骨折患者进行随访。I型骨折21例，II型骨折135例，III型骨折130例，IV型骨折212例。观察者内kappa系数范围为0.810 - 0.861，观察者间kappa系数范围为0.830 - 0.876，一致性较高。随访13个月后，采用Gartland-Werley评分系统评估患者手腕和手部的功能恢复情况。分析表明，95.78%的患者手腕功能评为优或良（n = 477），4.22%的患者评为尚可（n = 21），主要原因是治疗不当后发生了创伤后腕关节炎。所有这些病例均为IV型和III型骨折。这些数据证明了一种名为三柱分类法的新型分类系统在桡骨远端双柱冲压骨折分类中的应用。该方法反映了骨折的机制和严重程度，符合AO骨折分类原则。此外，它具有较高的一致性，可为临床诊断、治疗及预后评估提供参考价值。
