Zhang Lin-Yuan, Chi Ying-Jun, Liu Feng-Xiang, Gong Wei-Hua, Yu Chao, Tang Jian, Sun Yue-Hua, Zhu Zhen-An
Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China.
Zhongguo Gu Shang. 2021 Feb 25;34(2):101-7. doi: 10.12200/j.issn.1003-0034.2021.02.002.
To compare therapeutic effects of internal fixation with volar locking plate in treating extension and flexion type of distal radius fracture (DRF).
From January 2015 to June 2018, 103 patients with DRF were retrospectively analyzed. According to original fracture displacement direction, patients were divided into extension fracture(Colles) group and flexion fracture (Smith) group. In Colles fracture group, there were 24 males and 44 females aged from 20 to 79 years old with an average of (59.0±13.4) years old;according to AO classification, 9 patients of type A2, 13 patients of type A3, 16 patientsof type C1, 17 patients of type C2 and 13 patients of type C3;the time from injury to operation ranged from 2 to 9 days with an average of (3.9±0.8) days. In Smith fracture group, there were 15 males and 20 females, aged from 27 to 87 years old with an average of (60.1±15.3) years old;according to AO classification, 4 patienst of A2, 7 patients of A3, 14 patients of C1, 5 patients of C2 and 5 patients of C3;the time from injury to operation ranged from 2 to 6 days with an average of (4.1±0.9) days. Operation time, fracture healing time and postoperative complications were recorded between two groups. Disabilities of arm, shoulder and hand (DASH) score at 6 and 8 weeks, 6 and 8 months were used to evaluate functional recovery of affected limbs during each follow up. Volar tilt, radial inclination and radius height were measured at 8 months after operation. Mayo score was measured at 8 months after operation to evaluate recovery of limb function.
All patients were followed up for 8 to 30 months with an average of (14.8±4.3) months, and no difference in follow up between two groups (> 0.05). There were no statistical differences in operation time, fracture healing time and postoperative complications between two groups(>0.05). DASH score at 6 and 12 weeks in Colles fracture group were (37.24±5.08) and (19.68±4.55), while in Smith fracture group were (39.05±4.79) and (23.44±4.21);Colles fracture group was better than that of Smith fracture group (<0.001);while there were no differences in DASH score at 6 and 8 months between two groups (>0.05). Volar tilt of Smith fracture group (11.1±3.1)° was better than that of Colles fracture group (8.6±4.1) °, and there were no significant difference in radial inclination and radius height between two groups(>0.05). Also there was no significant difference in Mayo score between two group(>0.05).
Patients with Colles fracture and Smith fracture could receive good reduction and fixation through volar locking plate. The radiographic parameters of both groups recovered satisfactorily after operation. Recovery of volar tilt of Smith fracture group is better than that of Colles fracture group, and early recovery function of Colles fracture group is better than that of Smith group, but there is no significant difference in long-term wrist joint function and incidence of postoperative complications between two groups.
比较掌侧锁定钢板内固定治疗伸直型和屈曲型桡骨远端骨折（DRF）的疗效。
回顾性分析2015年1月至2018年6月收治的103例DRF患者。根据原始骨折移位方向，将患者分为伸直型骨折（Colles骨折）组和屈曲型骨折（Smith骨折）组。Colles骨折组男24例，女44例，年龄20～79岁，平均（59.0±13.4）岁；按AO分型，A2型9例，A3型13例，C1型16例，C2型17例，C3型13例；受伤至手术时间2～9天，平均（3.9±0.8）天。Smith骨折组男15例，女20例，年龄27～87岁，平均（60.1±15.3）岁；按AO分型，A2型4例，A3型7例，C1型14例，C2型5例，C3型5例；受伤至手术时间2～6天，平均（4.1±0.9）天。记录两组手术时间、骨折愈合时间及术后并发症。采用上肢、肩部和手部功能障碍（DASH）评分评估各随访期患侧肢体功能恢复情况，分别于术后6周、8周、6个月和8个月进行评分。于术后8个月测量掌倾角、桡偏角及桡骨高度。于术后8个月采用Mayo评分评估肢体功能恢复情况。
所有患者均获随访，随访时间8～30个月，平均（14.8±4.3）个月，两组随访时间差异无统计学意义（>0.05）。两组手术时间、骨折愈合时间及术后并发症差异均无统计学意义（>0.05）。Colles骨折组术后6周、12周DASH评分分别为（37.24±5.08）、（19.68±4.55），Smith骨折组分别为（39.05±4.79）、（23.44±4.21）；Colles骨折组优于Smith骨折组（<0.001）；两组术后6个月和8个月DASH评分差异无统计学意义（>0.05）。Smith骨折组掌倾角（11.1±3.1）°优于Colles骨折组（8.6±4.1）°，两组桡偏角及桡骨高度差异无统计学意义（>0.05）。两组Mayo评分差异无统计学意义（>0.05）。
Colles骨折和Smith骨折患者采用掌侧锁定钢板均能获得良好的复位和固定，两组影像学参数术后均恢复满意。Smith骨折组掌倾角恢复优于Colles骨折组，Colles骨折组早期功能恢复优于Smith骨折组，但两组远期腕关节功能及术后并发症发生率差异无统计学意义。
