Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China.
School of Basic Medical Sciences, Shenyang Medical College, 146 Huanghe North Street, Shenyang, 110034, Liaoning, China.
J Orthop Surg Res. 2023 Sep 9;18(1):669. doi: 10.1186/s13018-023-04162-0.
ue to the lack of consensus on the optimal surgical treatment for distal radius fractures (DRF) in elderly patients over 65 years old, the purpose of this study was to compare the efficacy of external fixation (EF) with Kirschner wires and volar locking plate (VLP) in the treatment of DRF through a retrospective cohort study. We hypothesized that there would be no significant difference in overall complications and functional recovery between the two methods.
We retrospectively analyzed 62 patients over 65 years old who underwent surgical treatment for C-type DRF between 2019 and 2022. Based on the different treatment methods, they were divided into the EF group and the VLP group. General data, inpatient data, and postoperative complications during follow-up were recorded. The X-ray images before surgery, after surgery, and at the last follow-up were analyzed, and the results of wrist motion range, Gartland-Werley wrist joint score, and DASH score were evaluated 6 months after surgery for both groups.
Thirty patients underwent closed reduction and external fixation combined with Kirschner wire fixation, while 32 underwent open reduction and VLP fixation. The EF group had significantly shorter operation time, intraoperative blood loss, injury-to-surgery time, and hospital stay compared to the VLP group (all p < 0.001). At the last follow-up, the radiographic parameters (ulnar variance and radial inclination) and wrist joint function (wrist dorsiflexion and forearm supination) were better in the VLP group than in the EF group (p = 0.04, p = 0.01, p = 0.001, p = 0.02, respectively). However, there was no significant difference in overall Gartland-Werley wrist joint score, DASH score, and incidence of postoperative complications between the two groups (p = 0.31, p = 0.25, p = 0.47, respectively).
For patients aged 65 and above with distal radius fractures (DRF) of type C, VLP and external fixation with Kirschner wires yield comparable functional outcome and complications rate at the short term. However, VLP allowed restoration of better radiological parameters.
由于对于 65 岁以上老年患者的桡骨远端骨折（DRF）的最佳手术治疗方法缺乏共识，本研究旨在通过回顾性队列研究比较外固定（EF）与克氏针和掌侧锁定钢板（VLP）治疗 DRF 的疗效。我们假设这两种方法在总体并发症和功能恢复方面没有显著差异。
我们回顾性分析了 2019 年至 2022 年间接受 C 型 DRF 手术治疗的 62 名 65 岁以上患者。根据不同的治疗方法，将其分为 EF 组和 VLP 组。记录一般资料、住院资料和随访期间的术后并发症。分析术前、术后和末次随访的 X 线片，并评估两组患者术后 6 个月的腕关节活动范围、Gartland-Werley 腕关节评分和 DASH 评分。
30 例患者行闭合复位外固定联合克氏针固定，32 例行切开复位 VLP 固定。EF 组的手术时间、术中出血量、伤后至手术时间和住院时间均明显短于 VLP 组（均 p<0.001）。末次随访时，VLP 组的影像学参数（尺偏距和掌倾角）和腕关节功能（腕背伸和前臂旋前）均优于 EF 组（p=0.04、p=0.01、p=0.001、p=0.02）。然而，两组患者的总体 Gartland-Werley 腕关节评分、DASH 评分和术后并发症发生率差异均无统计学意义（p=0.31、p=0.25、p=0.47）。
对于年龄在 65 岁及以上的 C 型桡骨远端骨折患者，VLP 和外固定联合克氏针的治疗效果和短期并发症发生率相当，但 VLP 可更好地恢复影像学参数。
