Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Orthop Surg. 2022 Oct;14(10):2489-2498. doi: 10.1111/os.13468. Epub 2022 Aug 26.
To investigate the clinical and radiological outcomes of distal radius fractures (DRFs) with displaced dorsal ulnar fragments treated with volar locking plate (VLP) and the "poking reduction" technique.
Between January 2014 and January 2019, 78 unilateral DRFs with displaced dorsal ulnar fragment (AO type C3) treated with VLP were conducted. According to the reduction technique of the dorsal ulnar fragment, the patients were divided into the conventional reduction (CRG) group (33 patients, 14 males and 19 females, mean age 57.2 ± 12.1 years old) and the "poking reduction" (PRG) group (45 patients, 11 males and 34 females, mean age 60.1 ± 12.4 years old). According to the AO classification, there were 21 cases of C3.1 and 12 of C3.2 in the CPG group, 27 cases of C3.1 and 18 of C3.2 in the PRG group. Clinical and radiographic data were extracted from the electronic medical record system. These data were reviewed for clinical outcomes (range of motion, grip strength), radiological outcomes (volar tilt, radial inclination, radial height, step of articular surface), and postoperative complications. The final functional recovery was evaluated by the disabilities of the arm, shoulder, and hand (DASH) score.
The mean duration of follow-up was 27 months (range from 12 to 56). The average operation time and intraoperative blood loss did not significantly differ between groups (p > 0.05). Postoperative CT examination showed that the step of articular surface in CPG group (0.8 ± 0.3 mm) was larger than that in PRG group (0.5 ± 0.2 mm) (p < 0.001). The DASH score did not significantly differ between groups (26.1 ± 4.6 in CRG and 24.7 ± 4.0 in PRG, p > 0.05) at 3 months postoperatively. At 6 months and 12 months postoperatively, the DASH score was better in PRG group (11.8 ± 2.5 and 10.4 ± 2.0) than in CRG group (13.6 ± 2.7 and 12.2 ± 2.5) (p = 0.004, p = 0.001, respectively). At 12 months postoperatively, wrist range of motion did not significantly differ between groups (p > 0.05). There was no significant difference in radiological parameters between the two groups (p > 0.05). The incidence of complications was higher in the CRG group (7/33) than in the PRG group (2/45) (p = 0.009).
The "poking reduction" technique is a wise option for reduction of dorsal ulnar fragment in DRFs. This innovative technique could restore smoothness of the radiocarpal joint effectively, and the dorsal ulnar fragment could be fixed effectively combined with the volar plate.
探讨掌侧锁定板（VLP）结合“戳顶复位”技术治疗背侧桡骨远端骨折（DRF）伴背侧尺骨骨块的临床和影像学结果。
2014 年 1 月至 2019 年 1 月，对 78 例背侧桡骨远端骨折伴背侧尺骨骨块（AO 分型 C3）患者行 VLP 治疗。根据背侧尺骨骨块复位技术，将患者分为常规复位（CRG）组（33 例，男 14 例，女 19 例，平均年龄 57.2±12.1 岁）和“戳顶复位”（PRG）组（45 例，男 11 例，女 34 例，平均年龄 60.1±12.4 岁）。根据 AO 分类，CPG 组中有 21 例 C3.1 型和 12 例 C3.2 型，PRG 组中有 27 例 C3.1 型和 18 例 C3.2 型。从电子病历系统中提取临床和影像学数据。这些数据用于评估临床结果（关节活动度、握力）、影像学结果（掌倾角、桡骨倾斜角、桡骨高度、关节面台阶）和术后并发症。采用残疾问卷（DASH）评分评估最终功能恢复情况。
平均随访时间为 27 个月（12~56 个月）。两组间手术时间和术中出血量差异无统计学意义（p>0.05）。术后 CT 检查显示，CPG 组关节面台阶（0.8±0.3 mm）大于 PRG 组（0.5±0.2 mm）（p<0.001）。术后 3 个月，两组 DASH 评分差异无统计学意义（CRG 组 26.1±4.6，PRG 组 24.7±4.0，p>0.05）。术后 6 个月和 12 个月，PRG 组的 DASH 评分优于 CPG 组（11.8±2.5 和 10.4±2.0）（p=0.004，p=0.001）。术后 12 个月，两组腕关节活动度差异无统计学意义（p>0.05）。两组影像学参数差异无统计学意义（p>0.05）。CRG 组并发症发生率（7/33）高于 PRG 组（2/45）（p=0.009）。
“戳顶复位”技术是治疗背侧桡骨远端骨折伴背侧尺骨骨块的明智选择。该创新技术可有效恢复腕关节背侧的平滑度，结合掌侧钢板可有效固定背侧尺骨骨块。
