Mitsuzawa Sadaki, Takeuchi Hisataka, Tsukamoto Yoshihiro, Yamashita Shinnosuke, Ota Satoshi, Onishi Eijiro, Yasuda Tadashi
Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
J Wrist Surg. 2023 Jan 11;12(4):353-358. doi: 10.1055/s-0042-1760125. eCollection 2023 Aug.
The volar lip of the distal radius is the key structure for wrist joint stability. Rigid fixation of the volar lunate facet (VLF) fragment is difficult because of its unique anatomy, and a high rate of postoperative displacement was demonstrated. The aim of the study is to identify risk factors for VLF in distal radius fractures (DRFs) and to reconsider the important point for primary fixation. One hundred fifty-five patients who underwent open reduction and internal fixation for an DRF were included and classified into one of the following two groups: VLF(+)or VLF(-). Demographic data, including age, sex, body mass index (BMI), laterality, trauma mechanism, and AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification were recorded. Several parameters were investigated using wrist radiographs of the uninjured side and computed tomography scans of the injured side. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for VLF. There were 25 patients in the VLF(+) group and 130 patients in the VLF(-) group. The incidence of VLF was 16.1%. The VLF(+) group tended to have a higher BMI and higher energy trauma mechanism. The odds ratio for the sigmoid notch angle (SNA), volar tilt (VT), and lunate facet curvature radius (LFCR) were 0.84, 1.32, and 0.70, respectively, with multivariate analysis, which was significant. A smaller SNA, larger VT, and smaller LFCR are potential risk factors for VLF. Over-reduction of the VT at primary fixation should be avoided because it could place an excess burden on the VLF and cause subsequent postoperative fixation failure and volar carpal subluxation. IV.
桡骨远端掌侧唇是腕关节稳定性的关键结构。由于其独特的解剖结构，掌侧月骨小关节（VLF）骨折块的坚强固定较为困难，且术后移位率较高。
本研究的目的是确定桡骨远端骨折（DRF）中VLF的危险因素，并重新审视一期固定的要点。
纳入155例行DRF切开复位内固定术的患者，并将其分为以下两组之一：VLF（+）组或VLF（-）组。记录人口统计学数据，包括年龄、性别、体重指数（BMI）、患侧、创伤机制和AO基金会/骨创伤协会（AO/OTA）分类。使用未受伤侧的腕部X线片和受伤侧的计算机断层扫描对几个参数进行研究。进行单因素和多因素逻辑回归分析以评估VLF的危险因素。
VLF（+）组有25例患者，VLF（-）组有130例患者。VLF的发生率为16.1%。VLF（+）组往往具有较高的BMI和较高能量的创伤机制。经多因素分析，乙状切迹角（SNA）、掌倾角（VT）和月骨小关节曲率半径（LFCR）的比值比分别为0.84、1.32和0.70，差异有统计学意义。较小的SNA、较大的VT和较小的LFCR是VLF的潜在危险因素。
一期固定时应避免过度矫正VT，因为这可能会给VLF带来过大负担，导致术后固定失败和掌侧腕骨半脱位。
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