Kawamura Kenjiro, Naito Kiyohito, Suzuki Takamaru, Yamamoto Yasuhiro, Kawakita So, Imazu Norizumi, Ishijima Muneaki
Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan.
Med Int (Lond). 2024 Aug 14;4(6):65. doi: 10.3892/mi.2024.189. eCollection 2024 Nov-Dec.
In the present study, the clinical findings that interfere with the immediate return to activity following volar locking plate (VLP) fixation for distal radius fractures were investigated. A total of 95 patients who underwent VLP fixation for distal radius fracture between July, 2014 and January, 2022 were divided into a good group (good score and outcome; n=86; 22 males and 64 females; median age, 61 years) and a poor group (poor score and outcome; n=8; 8 females; median age, 63.6 years) according to the quartiles of the disabilities of the arm, shoulder and hand (Q-DASH) score, at 1 month following VLP fixation. The duration from injury to surgery, the direction of fracture dislocation and radiographic parameters [radial inclination (RI), volar tilt (VT) and ulnar variance (UV)] at the time of injury were examined. Radiographic parameters (RI, VT and UV), the range of motion of the wrist joint, grip strength ratio and visual analog scale (VAS) at 1 month following VLP fixation were also examined. These parameters were compared among both groups. Moreover, logistic regression analysis was performed to determine whether these factors were independently associated with a poor Q-DASH score at 1 month following VLP fixation. At the time of injury, fracture displacement was significantly higher in the poor group (VT, -23.8˚; UV, 4.2 mm) than the good group (VT, -6.5˚; P=0.02; UV, 1.3 mm; P=0.01). No differences in the other parameters were observed between the groups. At 1 month following VLP fixation, the grip strength ratio (17.2%) in the poor group was significantly lower than that in the good group (43.8%, P<0.001), while the VAS score (5.6) in the poor group was significantly higher than that in the good group (2.4, P<0.001). Logistic regression analysis revealed that VT and UV at injury (P<0.05), grip strength ratio (P<0.001) and pain (VAS score) (P<0.001) were all independently associated with a poor Q-DASH score. On the whole, the present study suggests that large amounts of fracture displacement, weakness of grip strength and post-operative pain can be factors interfering with the return to activity immediately following VLP fixation.
在本研究中，对影响桡骨远端骨折掌侧锁定钢板（VLP）固定后即刻恢复活动的临床因素进行了调查。对2014年7月至2022年1月期间因桡骨远端骨折接受VLP固定的95例患者，根据VLP固定后1个月时手臂、肩部和手部功能障碍评分（Q-DASH）的四分位数，分为恢复良好组（评分和结果良好；n = 86；男性22例，女性64例；中位年龄61岁）和恢复较差组（评分和结果较差；n = 8；女性8例；中位年龄63.6岁）。检查了受伤至手术的时间、受伤时骨折脱位的方向以及影像学参数[桡侧倾斜度（RI）、掌侧倾斜度（VT）和尺骨变异（UV）]。还检查了VLP固定后1个月时的影像学参数（RI、VT和UV）、腕关节活动范围、握力比和视觉模拟评分（VAS）。对两组之间的这些参数进行了比较。此外，进行了逻辑回归分析，以确定这些因素是否与VLP固定后1个月时Q-DASH评分较差独立相关。受伤时，恢复较差组的骨折移位（VT，-23.8˚；UV，4.2 mm）显著高于恢复良好组（VT，-6.5˚；P = 0.02；UV，1.3 mm；P = 0.01）。两组之间在其他参数上未观察到差异。VLP固定后1个月时，恢复较差组的握力比（17.2%）显著低于恢复良好组（43.8%，P < 0.001），而恢复较差组的VAS评分（5.6）显著高于恢复良好组（2.4，P < 0.001）。逻辑回归分析显示，受伤时的VT和UV（P < 0.05）、握力比（P < 0.001）和疼痛（VAS评分）（P < 0.001）均与Q-DASH评分较差独立相关。总体而言，本研究表明，大量的骨折移位、握力减弱和术后疼痛可能是影响VLP固定后即刻恢复活动的因素。
