使用固定角度掌侧钢板治疗桡骨远端骨折不植骨的早期骨不连

Nascent Malunion of Distal Radius Fractures Treated with Fixed Angled Volar Plates without Using Bone Grafts.

作者信息

Bezirgan Uğur, Acar Erdinç, Yoğun Yener, Savran Merve Dursun, Keskin Ömer Halit, Armangil Mehmet

机构信息

Faculty of Medicine, Orthopedics and Traumatology Department, Ibn'i Sina Hospital, Ankara University, Hand Surgery Unit, Sıhhiye/ANKARA TR, Ankara, Turkey.

Orthopedics and Traumatology Department, Ankara City Hospital, Hand Surgery Unit, Ankara, Turkey.

出版信息

Indian J Orthop. 2023 Mar 20;57(4):533-542. doi: 10.1007/s43465-023-00864-z. eCollection 2023 Apr.

DOI:10.1007/s43465-023-00864-z

PMID:37006733

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10050669/

Abstract

PURPOSE

Malunion of the distal radius is a common complication. Using bone grafts is common to restore the bone to an acceptable level. This study aimed to verify if it is necessary to use bone grafts in nascent malunion of distal radius fractures treated with fixed angled volar plates and which radiographic parameters are essential to obtain satisfactory outcomes.

METHODS

This single-centered prospective study included 11 patients who underwent corrective osteotomy of the radius for malunion. Patients with a metaphyseal, extraarticular osteotomy stabilized by a volar fixed angle plate within 3 months after the fracture are included. Patients underwent a standard radiological evaluation at postoperative 1 month, 3 months, 6 months, 1 year, and annually thereafter. Radial inclination, radial height, ulnar variance, and palmar tilt were measured. Wrist ranges of motion are measured throughout follow-up with a goniometer. Grip strength is measured using a Jamar Hand Dynamometer. The function is evaluated via the Gartland-Werley (GW) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.

RESULTS

The mean age of 11 patients, 9 (81.82%) males, included in the study was 41.45 ± 14.89 years. The mean post-fracture admission time is 39.3 ± 15.1 days. Radial inclination, radial length, and ulnar variance improved significantly after surgery ( = 0.0023, 0.0002, 0.0037). Radial inclination values are within normal limits for all patients at admission. The radial length was in the normal range for 72.73%, the ulnar variance was in the normal range for 72.73%, and palmar tilt was in the normal range for 100% of the patients. Extension 54.55%, flexion 72.73%, radial deviation 81.82%, ulnar deviation 63.64%, pronation 90.91%, and supination 72.73% were achieved after surgery. GW average was 3.09 ± 3.24 DASH score average was 12.24 ± 13.48. The mean grip strength was 29.27 ± 7.21 on the operated side, while it was 34.91 ± 5.32, on the healthy side, with a significant difference ( = 0.0108).

CONCLUSION

It is possible to get good results without using bone grafts in corrective osteotomy of distal radius malunions.

摘要

目的

桡骨远端畸形愈合是一种常见的并发症。使用骨移植来将骨骼恢复到可接受水平很常见。本研究旨在验证在采用掌侧成角钢板治疗的桡骨远端新鲜畸形愈合中是否有必要使用骨移植，以及哪些影像学参数对于获得满意结果至关重要。

方法

这项单中心前瞻性研究纳入了11例行桡骨截骨矫正术治疗畸形愈合的患者。纳入骨折后3个月内采用掌侧固定角度钢板稳定干骺端、关节外截骨的患者。患者在术后1个月、3个月、6个月、1年及此后每年接受标准的放射学评估。测量桡骨倾斜度、桡骨高度、尺骨变异和掌倾角。在整个随访过程中使用角度计测量腕关节活动范围。使用Jamar握力计测量握力。通过Gartland-Werley（GW）评分和上肢、肩部和手部功能障碍（DASH）评分评估功能。

结果

本研究纳入的11例患者平均年龄为41.45±14.89岁，其中9例（81.82%）为男性。骨折后平均入院时间为39.3±15.1天（此处原文“ = 0.0023, 0.0002, 0.0037”疑似有误，应是用于统计分析的相关值，如P值等，但不影响整体理解）。术后桡骨倾斜度、桡骨长度和尺骨变异显著改善。所有患者入院时桡骨倾斜度值均在正常范围内。72.73%的患者桡骨长度在正常范围内，72.73%的患者尺骨变异在正常范围内，100%的患者掌倾角在正常范围内。术后实现了伸展54.55%、屈曲72.73%、桡偏81.82%、尺偏63.64%、旋前90.91%和旋后72.73%。GW平均分为3.09±3.24，DASH评分平均分为12.24±13.48。患侧平均握力为29.27±7.21，而健侧为34.91±5.32，差异有统计学意义（此处原文“ = 0.0108”疑似有误，应是用于统计分析的相关值，如P值等，但不影响整体理解）。