掌侧锁定钢板固定桡骨远端骨折后尺骨茎突基底部骨折愈合的预测因素。
Factors predictive for union of basal fracture of the ulnar styloid process after distal radial fracture fixation using a volar locking plate.
机构信息
Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
出版信息
Injury. 2021 Mar;52(3):524-531. doi: 10.1016/j.injury.2020.10.088. Epub 2020 Oct 19.
BACKGROUND
Some basal ulnar styloid fractures (USFs) achieve union without surgical fixation when accompanying distal radius fractures (DRFs) are treated via placement of volar locking plates (VLPs). The purpose of this study was to seek factors predictive of such healing through the retrospective case-control study.
METHODS
We evaluated 203 patients who received VLPs to treat DRFs in our institute from March 2010 to February 2018; Group 1 contained "union" patients and Group 2 contained "nonunion" patients. Basic demographic, radiological, and operative variables were compared. At the final follow-up (at least 2 years postoperatively), pain was scored using a visual analog scale (VAS). Scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) instrument; grip strengths; and demerit points of the Gartland and Werley system were compared between groups.
RESULTS
Group 1 consisted of 58 patients and Group 2 consisted of 147 patients. Univariate analysis showed that age, bone mineral density (BMD), and Gaulke USF classification significantly differed between groups (all p < 0.05). Multivariate analysis showed that BMD (p < 0.001, odds ratio [OR] = 0.214, 95% confidence interval [95% CI] = 0.126-0.363) and Gaulke classification (p < .001, OR = 0.092, 95% CI = 0.034-0.250) were significantly associated with USF union, which was significantly higher in patients with mean BMD ≥ -0.12 (the cutoff value) and type IIC USFs. However, postoperative clinical outcomes at the final follow-up did not differ significantly between groups (all p > 0.05).
CONCLUSIONS
Approximately 30% (58/205) of basal USFs associated with DRFs united after VLPs alone were placed to treat the DRFs. BMD ≥ -0.12 independently predicted union. Type IIC USFs exhibited more union than other fracture types. Additional surgical fixation of a basal USF accompanied by a DRF treated via VLP placement may be unnecessary, especially if BMD is good and fracture type is IIC.
LEVEL OF EVIDENCE
Level III, Case-control study.
背景
当通过掌侧锁定钢板（VLP）治疗伴随的桡骨远端骨折（DRF）时，一些基底尺骨茎突骨折（USF）在无需手术固定的情况下也能愈合。本研究旨在通过回顾性病例对照研究，寻找与这种愈合相关的预测因素。
方法
我们评估了 203 名在我院接受 VLP 治疗 DRF 的患者；其中，第 1 组为“愈合”患者，第 2 组为“不愈合”患者。比较了基本的人口统计学、影像学和手术变量。在最后一次随访（术后至少 2 年）时，使用视觉模拟评分（VAS）对疼痛进行评分。比较两组间的手臂、肩部和手部残疾（DASH）仪器评分、握力、Gartland 和 Werley 系统的扣分。
结果
第 1 组包括 58 例患者，第 2 组包括 147 例患者。单因素分析显示，两组间年龄、骨密度（BMD）和 Gaulke USF 分类有显著差异（均 p<0.05）。多因素分析显示，BMD（p<0.001，优势比[OR] = 0.214，95%置信区间[95%CI] = 0.126-0.363）和 Gaulke 分类（p<0.001，OR = 0.092，95%CI = 0.034-0.250）与 USF 愈合显著相关，BMD≥-0.12（截断值）和 IIC 型 USF 患者的愈合率显著更高。然而，末次随访时的术后临床结果在两组间无显著差异（均 p>0.05）。
结论
大约 30%（58/205）与 DRF 相关的基底 USF 在单独放置 VLP 治疗 DRF 后愈合。BMD≥-0.12 可独立预测愈合。IIC 型 USF 较其他骨折类型有更高的愈合率。对于通过 VLP 放置治疗的 DRF 合并的基底 USF，可能无需额外的手术固定，尤其是在 BMD 良好且骨折类型为 IIC 时。
证据等级
III 级，病例对照研究。
Zotero 插件