盖氏骨折脱位手术固定后稳定型下尺桡关节两周与四周固定的随机对照试验

Two-week versus four-week immobilization of stable distal radioulnar joint following surgical fixation of Galeazzi fracture-dislocations: A randomized controlled trial.

作者信息

Sukpanichyingyong Sermsak, Sangkomkamhang Thananit, Foocharoen Thanit

机构信息

Department of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand.

出版信息

J Clin Orthop Trauma. 2023 Nov 8;45:102279. doi: 10.1016/j.jcot.2023.102279. eCollection 2023 Oct.

DOI:10.1016/j.jcot.2023.102279

PMID:38009090

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10665924/

Abstract

BACKGROUND

Postoperative immobilization protocols following surgical fixation of Galeazzi fracture-dislocations (GFD) in adults remain unresolved. This study aimed to compare outcomes of two different immobilization durations (two weeks versus four weeks) in terms of functional outcomes and complications.

METHODS

Participants were prospectively and randomly enrolled in two-week versus four-week immobilization after plate fixation of GFD when the distal radioulnar joint (DRUJ) was reducible and stable postoperatively. Immobilization involved an above-elbow splint with the forearm in full supination. Demographic data, including age, gender, mechanism of injury, fracture characteristics, and treatment approach, were recorded. The primary outcome was the abbreviated version of the Disability of Arm, Shoulder, and Hand (DASH) scores at three months post-operation. Secondary outcomes included wrist range of motion, mean grip strength differences between injured and uninjured sides, and complications.

RESULTS

A total of 54 participants were enrolled and randomized into two treatment groups. Demographics were similar between groups, with most participants being male, and the mean age was 35 years (range 18-65). Fractures were generally less than 10 cm. The mean DASH scores were slightly higher in the four-week immobilization group but not statistically significant (1.43 in the two-week immobilization group vs. 2.36 in the four-week immobilization group, p = 0.152). Range of motion and mean grip strength differences were similar between groups. Complication rates were also similar, with recurrent DRUJ dislocation occurring in two participants from each group.

CONCLUSION

This study found no significant differences in functional outcomes and complications between two-week and four-week immobilization durations after plate fixation of GFD when the DRUJ was reducible and stable postoperatively.

LEVEL OF EVIDENCE

Therapeutic Level I.

摘要

背景

成人盖氏骨折脱位（GFD）手术固定后的术后固定方案仍未确定。本研究旨在比较两种不同固定时长（两周与四周）在功能结局和并发症方面的差异。

方法

当尺桡远侧关节（DRUJ）术后可复位且稳定时，对GFD钢板固定后的患者进行前瞻性随机分组，分别接受两周或四周的固定。固定采用上臂夹板，前臂完全旋前。记录人口统计学数据，包括年龄、性别、损伤机制、骨折特征和治疗方法。主要结局是术后三个月时上肢、肩部和手部功能障碍（DASH）评分的简化版。次要结局包括腕关节活动范围、患侧与健侧平均握力差异以及并发症。

结果

共纳入54名参与者并随机分为两个治疗组。两组的人口统计学特征相似，大多数参与者为男性，平均年龄为35岁（范围18 - 65岁）。骨折一般小于10厘米。四周固定组的平均DASH评分略高，但无统计学意义（两周固定组为1.43，四周固定组为2.36，p = 0.152）。两组间的活动范围和平均握力差异相似。并发症发生率也相似，每组各有两名参与者发生复发性DRUJ脱位。