Lenoble E, Dumontier C, Goutallier D, Apoil A
Department of Orthopaedic Surgery and Trauma, Henri Mondor Hospital, Creteil, France.
J Bone Joint Surg Br. 1995 Jul;77(4):562-7.
We performed a prospective study on 96 patients with extra-articular or intra-articular fractures of the distal radius with a dorsally displaced posteromedial fragment. After closed reduction, we compared trans-styloid fixation and immobilisation with Kapandji fixation and early mobilisation. Forty-two patients of mean age 57.1 years +/- 18.1 (SD) were treated by trans-styloid K-wire fixation and 45 days of short-arm cast immobilisation. Fifty-four patients of mean age 57.7 years +/- 18.7 (SD) had Kapandji fixation and immediate mobilisation according to the originator. All the patients had clinical and radiological review at about six weeks and at 3, 6, 12 and 24 months after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, radial tilt, ulnar variance, and radial shortening were assessed radiologically. Statistical analysis was applied to comparisons with the normal opposite wrist. Pain and reflex sympathetic dystrophy were more frequent after Kapandji fixation and early mobilisation, but the range of motion was better although this became statistically insignificant after six weeks. The radiological reduction was better soon after Kapandji fixation, but there was some loss of reduction and increased radial shortening during the first three postoperative months. The clinical result at two years was similar in both groups.
我们对96例桡骨远端关节外或关节内骨折且伴有后内侧骨折块背侧移位的患者进行了一项前瞻性研究。闭合复位后，我们比较了经茎突固定并制动与卡潘迪固定及早期活动的效果。42例平均年龄为57.1岁±18.1（标准差）的患者接受了经茎突克氏针固定及45天的短臂石膏制动。54例平均年龄为57.7岁±18.7（标准差）的患者根据发明者的方法进行了卡潘迪固定并立即活动。所有患者在术后约6周以及3、6、12和24个月时进行了临床和影像学检查。临床测试疼痛、活动范围和握力，并通过影像学评估背侧倾斜、桡侧倾斜、尺骨变异和桡骨短缩的变化。应用统计分析与对侧正常手腕进行比较。卡潘迪固定及早期活动后疼痛和反射性交感神经营养不良更为常见，但活动范围更好，不过6周后这在统计学上变得不显著。卡潘迪固定后不久影像学复位更好，但术后前三个月有一些复位丢失和桡骨短缩增加。两组两年时的临床结果相似。
