Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Hand Surg Asian Pac Vol. 2023 Feb;28(1):61-68. doi: 10.1142/S2424835523500091. Epub 2023 Feb 20.
This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly. The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015-2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients ( = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group. After matching, the backgrounds of Groups VLA ( = 388) and VLS ( = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, < 0.001). In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF. Level IV (Therapeutic).
本多中心回顾性研究旨在比较掌侧锁定板（VLP）固定不稳定桡骨远端骨折（DRF）时，使用骨替代物与单纯使用 VLP 固定的临床结果和成本效益。从数据库（命名为 TRON）中提取了 2015 年至 2019 年期间接受 VLP 手术治疗的年龄≥65 岁的 1980 例 DRF 患者的数据。排除失访或接受自体骨移植的患者。将患者（n=1735）分为单纯 VLP 固定组（VLA 组）和 VLP 固定联合骨替代物组（VLS 组）。对背景特征（比例 4:1）进行倾向评分匹配。采用改良 Mayo 腕关节评分（MMWS）评估临床结果。评估假体失败率、骨愈合率、掌倾角（VT）、桡骨倾斜角（RI）、尺侧骨间距离（UV）和远背侧皮质距离（DDD）作为影像学参数。还比较了每组的初始手术费用和总费用。 匹配后，VLA 组（n=388）和 VLS 组（n=97）的背景无显著差异。两组 MMWS 值无显著差异。影像学评估显示两组均无假体失败。两组患者均确认骨愈合。两组 VT、RI、UV 和 DDD 值无显著差异。VLS 组的初始手术费用和总费用明显高于 VLA 组（$3515 比$3068，<0.001）。 对于年龄≥65 岁的 DRF 患者，VLP 固定联合骨替代物与单纯 VLP 固定的临床和影像学结果无差异，但额外使用骨增强与更高的医疗费用相关。对于 DRF 老年患者，应更严格考虑使用骨替代物的适应证。 四级（治疗）。
