Koo Siu Cheong Jeffrey Justin, Leung Kam Yiu Adrian, Chau Wai Wang, Ho Pak Cheong
Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong.
Occupational Therapy Department, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong.
J Wrist Surg. 2021 Apr;10(2):102-110. doi: 10.1055/s-0040-1719039. Epub 2020 Nov 4.
Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27-73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5-26) after surgery. Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. This is a level III, retrospective cohort study.
桡骨远端骨折是最常见的损伤之一。当关节面台阶样移位和间隙导致关节内纤维组织形成时，可出现腕关节活动受限的功能不良结果。 本研究的目的是比较关节镜辅助复位与透视下复位治疗不稳定关节内桡骨远端骨折的功能和影像学结果。 我们回顾性分析了12例采用关节镜辅助骨折复位内固定治疗的关节内AO C型桡骨远端骨折患者，并将其与另一组仅通过透视评估骨折复位情况的12例患者进行比较（15例男性和9例女性，平均年龄57.3岁，范围27 - 73岁）。分析两组患者的影像学参数差异，包括关节面台阶样移位和间隙、掌倾角、桡偏角、尺骨变异，以及术后平均12.5个月（范围5 - 26个月）时的活动范围、握力、改良梅奥腕关节评分和上肢、肩部和手部快速残疾评定量表（DASH）评分等功能结果。 关节镜辅助骨折复位组在关节面台阶样移位和间隙、掌倾角和尺骨变异的恢复方面在统计学上有更好的表现。关节镜组的活动范围、握力、改良梅奥腕关节评分和快速DASH评分在统计学上也有显著改善。 我们的研究表明，关节镜辅助技术能够精确恢复高度粉碎性桡骨远端骨折的影像学参数，并取得良好的功能结果。此外，还能同时检测和治疗相关的关节内软组织损伤。 这是一项III级回顾性队列研究。
