外固定与掌侧锁定钢板治疗桡骨远端骨折的手术治疗：一项多中心随机对照试验。

Surgical Treatment of Distal Radial Fractures with External Fixation Versus Volar Locking Plate: A Multicenter Randomized Controlled Trial.

机构信息

University of Bergen, Bergen, Norway.

Division of Orthopaedic Surgery, Voss Hospital, Voss, Norway.

出版信息

J Bone Joint Surg Am. 2021 Mar 3;103(5):405-414. doi: 10.2106/JBJS.20.00275.

DOI:10.2106/JBJS.20.00275

PMID:33369985

Abstract

BACKGROUND

The use of volar locking plate fixation (VLP) for unstable extra-articular distal radial fractures has increased in the last decades. External fixation (EF) is less frequently used. This change of surgical approach has only to some extent been evidence-based.

METHODS

In this multicenter, randomized controlled trial, we compared VLP and EF in patients between 18 and 70 years of age who had a displaced extra-articular distal radial fracture (OTA/AO type A3). The patients were examined at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome measure was the Patient-Rated Wrist/Hand Evaluation score (PRWHE). Secondary outcomes were the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain score on a visual analog scale (VAS), and radiographic measurements. Range of motion, grip strength, finger stiffness, complications, and reoperations were also recorded.

RESULTS

One hundred and fifty-six patients were included. One hundred and forty-two (91%)-127 women (89%) and 15 men (11%)-completed 1 year of follow-up. Sixty-nine patients were treated with VLP and 73, with EF. The mean age was 56 years. At 6 weeks, the median PRWHE score was significantly higher in the EF group (44) compared with the VLP group (27) (p < 0.001). At 3 months and 1 year, the difference between groups was not significant. The median QuickDASH score was 27 in the VLP group and 43 in the EF group at 6 weeks (p < 0.001), and a significant difference persisted at 3 months (p = 0.023). The VLP group had superior results in terms pain during activity, wrist extension, and ulnar and radial deviation at 1 year, whereas the number of major complications was similar in the 2 groups.

CONCLUSIONS

Patients treated with VLP had earlier recovery of function compared with patients treated with EF. One year postoperatively, we found no significant functional difference.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

在过去几十年中，掌侧锁定钢板固定（VLP）在不稳定的关节外桡骨远端骨折中的应用有所增加。外固定（EF）的使用则较少。这种手术方法的改变在某种程度上还没有得到充分的证据支持。

方法

在这项多中心、随机对照试验中，我们比较了 VLP 和 EF 在 18 至 70 岁、有移位的关节外桡骨远端骨折（OTA/AO 型 A3）的患者中的应用。患者在术后 6 周、3 个月和 1 年进行检查。主要观察指标是患者腕/手评估评分（PRWHE）。次要观察指标是手臂、肩部和手残疾的简化版（QuickDASH）、视觉模拟评分法（VAS）疼痛评分和影像学测量。还记录了活动范围、握力、手指僵硬、并发症和再次手术的情况。

结果

共纳入 156 例患者。142 例（91%）-127 例女性（89%）和 15 例男性（11%）-完成了 1 年的随访。69 例患者接受 VLP 治疗，73 例患者接受 EF 治疗。平均年龄为 56 岁。在 6 周时，EF 组的 PRWHE 评分中位数（44）明显高于 VLP 组（27）（p < 0.001）。在 3 个月和 1 年时，两组之间的差异无统计学意义。VLP 组的 QuickDASH 评分中位数为 27 分，EF 组为 43 分，6 周时差异显著（p < 0.001），3 个月时仍有显著差异（p = 0.023）。VLP 组在活动时疼痛、腕伸、尺偏和桡偏方面的结果在 1 年时更优，而两组的主要并发症数量相似。