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帕金森病患者桡骨远端骨折的手术治疗。

Operative Treatment of Distal Radius Fractures in Patients With Parkinson Disease.

机构信息

Mayo Clinic, Rochester, MN, USA.

出版信息

Hand (N Y). 2022 Dec;17(1_suppl):37S-42S. doi: 10.1177/15589447211028931. Epub 2021 Jul 3.

Abstract

BACKGROUND

Owing to the many unique disease characteristics of Parkinson disease (PD)-namely resting tremors, muscular rigidity, and poor bone quality-we hypothesized that this patient population would have inferior outcomes with surgical management of acute distal radius fractures (DRFs) compared with the literature available on the general population.

METHODS

This is a retrospective observational study performed at a single, level 1, academic center from 2001 to 2020 capturing all adult patients with an isolated, acute, and closed DRF that ultimately underwent operative treatment. codes were used to identify 30 patients for manual chart review. Several patient and fracture characteristics were accounted for and complications, reoperations, and failures of surgical intervention were recorded.

RESULTS

There was a total of 7/30 failures (23%), 6/30 reoperations (20%), and 12 complications in 9/30 wrists (complication rate, 30%) at a mean latest follow-up of 11 months (1.2-158 months). Of the 7 failures, 5 were due to loss of reduction, and 2 of them were deep infections with mean time to failure of 8.3 weeks (range, 11 days-5.2 months).

CONCLUSIONS

This study found a high rate of complications, reoperations, and early failure despite a short follow-up period and a small cohort of patients with PD treated surgically for a DRF. We recommend locked plating if suitable for the fracture type and early involvement of a multidisciplinary team to assist with medical optimization of PD to increase chances of a successful outcome.

摘要

背景

由于帕金森病(PD)具有许多独特的疾病特征,即静止性震颤、肌肉僵硬和骨质量差,我们假设与一般人群的文献相比,该患者群体在接受急性桡骨远端骨折(DRF)的手术治疗时,结果会较差。

方法

这是一项回顾性观察性研究,于 2001 年至 2020 年在一家单一的一级学术中心进行,共纳入 30 例接受手术治疗的急性、闭合性、单发 DRF 的成年患者。使用 代码识别 30 例患者进行手动病历审查。记录了几个患者和骨折特征,并记录了并发症、再次手术和手术干预失败的情况。

结果

在平均随访 11 个月(1.2-158 个月)时,共有 7/30 例(23%)失败、6/30 例(20%)再次手术和 9/30 例(30%)手腕的 12 例并发症。7 例失败中有 5 例是由于复位丢失,其中 2 例是深部感染,失败的平均时间为 8.3 周(范围为 11 天至 5.2 个月)。

结论

尽管随访时间短且 PD 患者接受手术治疗的 DRF 患者数量较少,但本研究发现并发症、再次手术和早期失败的发生率较高。我们建议对骨折类型进行锁定钢板固定,并尽早让多学科团队参与,协助对 PD 进行医学优化,以增加成功的机会。

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本文引用的文献

1
Surgical outcome of upper extremity fractures in patients with Parkinson's disease.
Sci Rep. 2020 Dec 3;10(1):21016. doi: 10.1038/s41598-020-78168-7.
3
The Effect of Malnutrition on Postoperative Complications Following Surgery for Distal Radius Fractures.
J Hand Surg Am. 2019 Sep;44(9):742-750. doi: 10.1016/j.jhsa.2019.05.004. Epub 2019 Jul 9.
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Complications of Volar Locked Plating of Distal Radius Fractures: A Prospective Investigation of Modern Techniques.
Hand (N Y). 2020 Sep;15(5):698-706. doi: 10.1177/1558944719828001. Epub 2019 Feb 15.
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Outcome of Reverse Shoulder Arthroplasty for Patients With Parkinson's Disease: A Matched Cohort Study.
Orthopedics. 2017 Jul 1;40(4):e675-e680. doi: 10.3928/01477447-20170509-03. Epub 2017 May 15.
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Risk factors for 30-day postoperative complications and mortality following open reduction internal fixation of distal radius fractures.
J Hand Surg Am. 2014 Dec;39(12):2373-80.e1. doi: 10.1016/j.jhsa.2014.09.017. Epub 2014 Oct 29.

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