掌侧锁定钢板固定后关节外远端桡骨骨折桡骨高度丢失。

Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation.

机构信息

Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and national Yang Ming University, Taipei, Taiwan; Department of Orthopedic Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

Orthop Traumatol Surg Res. 2021 Sep;107(5):102842. doi: 10.1016/j.otsr.2021.102842. Epub 2021 Feb 3.

DOI:10.1016/j.otsr.2021.102842

PMID:33548565

Abstract

BACKGROUND

Radial height is an important prognostic factor in treating distal radius fracture. However, does further collapse of radial height in distal radius fractures after with volar locking plate fixation have a great impact on the prognosis? The present study aimed to elucidate radial height loss and determine the associated risk factors after open reduction and internal fixation with volar locking plate in patients with extra-articular distal radius fractures.

HYPOTHESIS

Patients with radial height collapse after fracture reduction and internal fixation with a volar locking plate may have poor outcomes.

METHODS

Data of 87 patients (21 male) undergoing surgery for acute extra-articular distal radius fractures (AO: 23-A2 or 23-A3) between February 2014 and July 2016 were evaluated retrospectively. Patients were divided into two groups by radial height loss. Potential risk factors were tested by Pearson correlation coefficients. Stepwise multiple regression logistic analysis determined significant independent risk factors for extra-articular distal radius fractures. Clinical evaluation was performed by the same surgeon by determining wrist ROM. Grip strength was measured with a Jamar dynamometer and compared with non-affect wrist in percentage. In addition, all the patients were asked to grade modified Mayo wrist score and Visual Analogue Scale (VAS) score. These findings were recorded postoperative 1 year of follow-up.

RESULTS

Mean radial height loss was 1.3±0.9mm. Age (ß=0.002, p=0.003), postoperative ulnar-positive deformity (ß=0.107, p<0.001), DEXA (ß=-0.015, p=0.008), and shortest diameter of distal fracture fragment in AP and lateral views (ß=-0.050, p=0.037; ß=-0.080, p=0.043) were significantly associated with radial height loss. As for the outcome of clinical prognosis, though radial height collapse group had poorer wrist range of motion, there was no statistical difference. Besides, there were no significant differences in grips strength and VAS score between these two groups. However, in regards of modified Mayo wrist score, the percentage of patients with poor outcomes is significant higher in radial height collapse group (p=0.039). Moreover, all patients with poor outcomes in radial height collapse groups were older than 65-year-old.

DISCUSSION

Radial height loss is noted in patients undergoing open reduction and internal fixation with volar locking plate for extra-articular distal radius fractures. Risk factors for radial height collapse include advanced age, poor bone quality, shortest distance between fracture site and articular surface and postoperative ulnar-positive deformity.

LEVEL OF EVIDENCE

IV; non-comparative prospective study.

摘要

背景

桡骨高度是治疗桡骨远端骨折的一个重要预后因素。然而，掌侧锁定钢板固定治疗桡骨远端骨折后桡骨高度进一步塌陷是否对预后有很大影响？本研究旨在阐明掌侧锁定钢板内固定治疗桡骨远端关节外骨折后桡骨高度丢失的情况，并确定相关的危险因素。

假说

骨折复位和掌侧锁定钢板内固定后桡骨高度塌陷的患者可能预后不佳。

方法

回顾性分析 2014 年 2 月至 2016 年 7 月接受急性桡骨远端关节外骨折（AO：23-A2 或 23-A3）手术的 87 例患者（21 例男性）的数据。根据桡骨高度丢失情况将患者分为两组。通过 Pearson 相关系数测试潜在的危险因素。逐步多元回归逻辑分析确定桡骨远端关节外骨折的显著独立危险因素。由同一位外科医生通过测定腕关节 ROM 进行临床评估。用 Jamar 测力计测量握力，并以百分比形式与非受影响的手腕进行比较。此外，所有患者均被要求对改良 Mayo 腕关节评分和视觉模拟评分（VAS）进行评分。这些发现记录在术后 1 年的随访中。

结果

平均桡骨高度丢失为 1.3±0.9mm。年龄（ß=0.002，p=0.003）、术后尺偏阳性畸形（ß=0.107，p<0.001）、DEXA（ß=-0.015，p=0.008）和桡骨远端骨折碎片在 AP 和侧位的最短直径（ß=-0.050，p=0.037；ß=-0.080，p=0.043）与桡骨高度丢失显著相关。至于临床预后的结果，尽管桡骨高度塌陷组的腕关节活动范围较差，但无统计学差异。此外，两组的握力和 VAS 评分无显著差异。然而，在改良 Mayo 腕关节评分方面，桡骨高度塌陷组的不良结局患者比例显著更高（p=0.039）。此外，桡骨高度塌陷组所有不良结局患者的年龄均大于 65 岁。