Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial

AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODS A prospective, randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate(n = 29), or another treatment modality(n = 27; cast immobilisation with or without wires or external fixator). Outcomes were measured at 12 wk. Functional outcome scores measured were the Patient-Rated Wrist Evaluation(PRWE) Score; Disabilities of the Arm, Shoulder and Hand and activities of daily living(ADLs). Clinical outcomes were wrist range of motion and grip strength. Radiographic parameters were volar inclination and ulnar variance.RESULTS Patients in the volar locking plate group had significantly better PRWE scores, ADL scores, grip strength and range of extension at three months compared with the control group. All radiological parameters were significantly better in the volar locking plate group at 3 mo. CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities. Anatomical reduction was significantly more likely to be preserved in the plating group. Level of evidence: Ⅱ.

Distal radius volar rim plate: Technical and radiographic considerations

AIM To determine technical considerations and radiographic outcomes of the Synthes volar rim distal radius plate to treat complex intra-articular fractures. METHODS This review highlights technical considerations learnt using this implant since it was introduced in a major trauma unit in November 2011, including anatomical reduction and whether this was maintained radiographically. RESULTS Twenty-six of the 382 internally fixed distal radial fractures at our unit(6.8%) were deemed to require this plate in order to achieve optimal fracture fixation between November 2011 and May 2014. A further dorsal and/or radial plate was necessary in 35% and variable angle screws were used in 54% of cases. Postoperatively, mean radial height, inclination, volar tilt and ulnar variance restored were 11.7 mm, 21o, 4.3o and-1.2 mm respectively. There were no cases of non-union or flexor/extensor tendon rupture; one case of loss of fracture reduction. Overall incidence of plate removal was 15% with one plate removed for flexor and one for extensor tendon irritation CONCLUSION The use of a rim plate enables control of challenging fardistal fracture patterns. However, additional plates were required to improve and maintain reduction. Variable angle screws were necessary in half the cases to avoid intra-articular screw penetration. If used judiciously, this implant can achieve stable fixation despite the complexity of the fracture pattern.

Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates

AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study. We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening. No other patient, injury, or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

Background: There is a large assortment of modalities for the surgical treatment/management of distal radius fractures (DRFs), where the most widely used is the fixed-angle volar plating (VLP) system, which, sometimes, is referred to as the “surgical modality of choice”. While outcomes with each modality are usually good to excellent, each has its share of shortcomings and complications. Thus, there is scope for improvements to existing modalities and/or introduction of new ones. Study Purpose: We introduce a novel modality, namely, the prototype of an intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis (IPBO) system, and investigated its plausibility. Experimental Procedures: The biomechanical performance of a construct comprising a synthetic distal radius (fourth-generation Sawbones?) on which a simulated fracture was created (4-mm wide osteotomy positioned 25 mm from the most distal end of the radius) and fixated with a placement of the IPBO system (SIPBO Construct) was compared to that when the fixation was with an approved Ti-6Al-4V alloy VLP system (SVLP Construct), under a clinically-relevant compressive loading protocol. Performance involved determination of quantitative parameters of the construct (initial longitudinal stiffness (ICLS), final longitudinal stiffness (FCLS), and load-to-failure (Pf)) and observation and recording of features of the construct at the fracture point. We also determined the quantitative parameters for the intact synthetic distal radius (control). Results: For each of the quantitative parameters, the range of values for SIPBO Construct was within that for SVLP Construct, suggesting that the IPBO System is a plausible modality. Also, for SIPBO Construct, failure occurred within the polymer zone, whereas, for SVLP Construct, some failure features were fracture of the cortical wall and of the dorsal proximal fragments. Conclusion: The findings suggest that the IPBO system is plausible. As such, it merits further study;for example, determination of the influence of fracture gap fill ratio (defined as the proportion of the fracture gap that is filled by the expanding balloon as the polymer is injected into the balloon) on a large collection of quantitative biomechanical parameters.

Difference in cortical activation during use of volar and dorsal hand splints:a functional magnetic resonance imaging study

There have been no studies reported on the difference in cortical activation during use of volar and dorsal hand splints.We attempted to investigate the difference in cortical activation in the somatosensory cortical area during use of volar and dorsal hand splints by functional magnetic resonance imaging（f MRI）.We recruited eight healthy volunteers.f MRI was performed while subjects who were fitted with volar or dorsal hand splints performed grasp-release movements.Regions of interest were placed on the primary motor cortex（M1）,primary somatosensory cortex（S1）,posterior parietal cortex（PPC）,and secondary somatosensory cortex（S2）.Results of group analysis of f MRI data showed that the total numbers of activated voxels in all ROIs were significantly higher during use of volar hand splint（3,376） compared with that（1,416） during use of dorsal hand splint.In each ROI,use of volar hand splint induced greater activation in all ROIs（M1：1,748,S1 ：1,455,PPC：23,and S2：150） compared with use of dorsal hand splint（M1：783,S1：625,PPC：0,and S2：8）.The peak activated value was also higher during use of volar hand splint（t-value：17.29） compared with that during use of dorsal hand splint（t-value：13.11）.Taken together,use of volar hand splint induced greater cortical activation relevant to somatosensory function than use of dorsal hand splint.This result would be important for the physiatrist and therapist to apply appropriate somatosensory input in patients with brain injury.

Comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia

Objectives: Local digital nerve blockade is frequently used in many trauma cases. Two commonly used techniques of digital nerve block with local anesthetic are the two-injection dorsal technique and the single-injection volar subcutaneous technique. In this study we compare various parameters of the single-injection volar subcutaneous block and the two-injection dorsal block. Pain score, amount of injected anesthetic, time of effect onset, patients’ and physicians’ satisfaction scores in each injection technique was compared. Methods: 128 participating patients were randomly divided into two equal experimental groups. Two-percentage Lidocaine was used as an anesthetic agent. Doses of 1.8 and 3-4 ml were used in the single-injection subcutaneous block and the two-injection dorsal block groups, respectively. Following injections, the patients were asked to score their discomfort experience on a standard visual analog scale of 0 (no pain) to 10 (most pain imaginable). They also were asked to score the rate of their satisfaction from 1(no satisfaction) to 5 (most satisfaction). The onset of effect was determined using the pinprick test. Results: Our results demonstrate that the two-injection dorsal block technique imposes more pain but the pain score difference was not statistically significant. Both patients and physicians were more comfortable with the single-injection subcutaneous digital block method. This satisfaction difference was statistically significant. Conclusions: The single-injection method is more efficient and the patients were more pleased. The advantages of this method are its safety, user friendly, need of lower amount of anesthetic drug and its easiness to teach and learn.

Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Complications and shortcomings of volar plating, which is very widely used for surgical treatment of distal radius fractures, are well known. Thus, there is scope for alternative innovative surgical methods. In the present work, we used the finite element analysis method to compare the biomechanical performance of a model of a construct comprising a simulated distal radius fracture considered fixated using a notional intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis system (“fixator”) versus using a commercially-available volar locking plate (VP). The biomechanical parameters determined were longitudinal stiffness and factor of safety under each of the applied loads.?For the fixator model, 1) each of the biomechanical parameters was markedly influenced by fracture gap fill ratio (FGFR) (defined as the proportion of the volume of the fracture gap that is considered occupied by the expanded polymer-filled balloon)?but not by modulus of elasticity assigned to the polymer;2) with FGFR = 100%, stiffness was comparable to that of the Ti-6Al-4V alloy VP construct model;and 3) stiffness was within the range of literature values for stiffness of constructs comprising simulated fractures in fresh cadaveric distal radii fixated using metal volar locking plate. These results suggest that the fixator may be an alternative modality to metal volar plating and, as such, deserves further evaluation.

Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.

Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76&deg;and 64&deg;, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures

Purpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment.This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation.Methods:A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups:volar plate group and external fixator group.These patients aged between 18 and 60 years had unilateral fractures,and agreed to be included in the study.Patients with a history of fracture,bilateral fracture,associated other injuries,delayed injury for more than 2 weeks,open fracture,pre-existing arthrosis or disability,psychiatric illness and pathological fracture were excluded.Patients were followed up at 6 weeks,3 months,6 months and 1 year.The assessment of pain,functional activity,range of motion and grip strength was done at each stage of follow-up.The pain and functional activities were assessed by patient rated wrist evaluation(PRWE)score and disabilities of the arm,shoulder and hand(DASH)score.Results:Patients in volar plate group had superior PRWE score and DASH score at each stage of followup.At 1 year follow-up,the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group;while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group.They had better flexion and extension range of movement.They also had better pronation and supination range of motion at initial follow-up,however the difference get attenuated by 1 year.Volar plate group had significantly better grip strength than external fixator group.Complication rates were higher in external fixation group.Conclusion:Fixation with variable angle volar plate results in early wrist mobilization,better range of movement,less pain and disability and early return of function.

Functional thenar eminence myocutaneous flap for reconstruction of thumb volar defect

This case report describes the use of a Functional Thenar Eminence myocutaneous flap for reconstruction of volar defect of distal right thumb of a 25-year-old male who sustained a twisting injury while working. Part of bone and tendon were exposed and the tip of the distal phalanx was crushed, with bony defect.

累及背侧关节面桡骨远端骨折的骨折线地图特征:螺钉有效固定治疗术后移位

背景:掌侧锁定钢板固定是桡骨远端骨折临床上最常用的固定方式,但当骨折线累及背侧关节面时,掌侧钢板固定则存在术后背侧骨块移位风险,尤其是乙状切迹背侧骨块术后移位风险较高。目的:分析桡骨远端骨折累及背侧关节面的骨折线特点,进而深入研究累及乙状切迹背侧骨块发生术后移位的危险因素,为临床上提高复位成功率提供依据。方法:对2021年1月至2022年9月在广州中医药大学第三附属医院就诊的桡骨远端骨折患者进行回顾性分析。根据术前CT影像桡骨远端背侧骨折块数量1,2,3块及以上分别记为Ⅰ,Ⅱ,Ⅲ型骨折,分别绘制骨折线地图,分析其背侧骨折线形态特征。对存在乙状切迹背侧骨折的患者进行3个月以上随访,根据术后是否发生乙状切迹背侧骨块移位分为移位组和无移位组,比较两组患者年龄、性别、术前和术后CT解剖参数。结果与结论:①对AO/OTA分型C型累及背侧关节面145例患者进行骨折线地图分析,其中根据背侧骨折块数量:Ⅰ型25例(17.2%)、Ⅱ型82例(56.6%)、Ⅲ型38例(26.2%);骨折线地图显示Ⅰ型骨折块骨折线主要累及乙状切迹,Ⅱ型主要累及乙状切迹和lister结节,Ⅲ型则累及乙状切迹、lister结节和桡侧柱背侧。145例患者中86.2%(125/145例)累及乙状切迹,其中Ⅲ型累及比例高达94.7%(36/38例),Ⅱ型88.0%(72/82例),Ⅰ型68%(17/25例)。②76例AO/OTA分型C型累及乙状切迹背侧患者纳入进一步研究,其中术后未移位组65例,移位组11例;在单因素分析中,两组患者的年龄、性别、受伤部位、术前CT乙状切迹背侧骨块背侧边长(d1)、尺侧边长(d2)、乙状切迹背侧骨块背侧高度(d4)和钢板距桡骨尺侧边缘距离(d5)比较差异均无显著性意义(P>0.05);乙状切迹背侧骨块累及下尺桡关节占比[d2/(d2+d3)]、乙状切迹背侧骨块关节面占比(s1/s2)、尺侧螺钉尾端距背侧乙状切迹边缘的距离(d6)和乙状切迹背侧骨块螺钉固定的数量比较差异有显著性意义(P<0.05)。③Logistic多因素回归分析显示,乙状切迹骨块螺钉固定的数量是影响尺背侧乙状切迹骨块移位唯一的危险因素(P<0.05)。④提示在累及桡骨背侧的桡骨远端关节内骨折中,Ⅱ型最常见,Ⅲ型和Ⅰ型次之,大部分患者均存在乙状切迹背侧骨块。而乙状切迹背侧骨块其受下尺桡关节韧带影响易发生术后移位,术中至少1枚有效螺钉固定能降低其移位风险并有助于提高治疗效果。

经皮双外固定架与外固定架联合接骨板治疗AO C型桡骨远端骨折的对比研究

目的比较经皮双外固定架(EF)与EF联合掌侧接骨板(VLP)治疗AO C1、C2和C3型桡骨远端骨折的疗效。方法回顾2019-2022年108例AO C型桡骨远端骨折患者的资料,其中51例患者采用双EF(无桥接骨水泥克氏针框架和传统跨腕EF)治疗,57例患者采用传统跨腕EF联合VLP治疗。测量两组患者的影像学参数(桡骨掌倾角、桡骨尺偏角、桡骨茎突高度、尺骨变异等)、腕关节活动度及握力,采用视觉模拟量表(VAS)评估腕部疼痛强度,通过上肢功能障碍评定量表(DASH)评估上肢的整体功能,通过Mayo腕关节评分系统(MWS)评估腕关节功能,采用患者满意度短期评估量表(SAPS)评估患者满意度。根据患者主诉及外科医师的综合判断评估患者的并发症发生情况。结果两组患者在年龄、性别、致伤原因、AO分型及手术时间方面差异均无统计学意义(均P>0.05);双EF组在手术等待时间、术中出血量、住院天数方面均优于EF联合VLP组(均P<0.001)。术后随访24~33个月。末次随访时,两组患者桡骨掌倾角、桡骨尺偏角、桡骨茎突高度、尺骨变异差异均无统计学意义(均P>0.05)。末次随访时,双EF组在VAS疼痛评分及SAPS患者满意度评分方面均优于EF联合VLP组(P=0.025、0.015),两组间腕关节活动范围(屈曲、背伸、桡偏、尺偏、旋前、旋后)、握力及MWS、DASH评分差异均无统计学意义(均P>0.05)。双EF组总体并发症发生率为13.73%(7/51),低于EF联合VLP组的28.07%(16/57)(P<0.05)。结论经皮双EF技术操作简单、安全、并发症少、随访效果满意,可作为OA C型桡骨远端骨折的一种治疗选择。

Preparation and Characterization of Hydrogel Materials Based on the Hydrothermal Liquefaction of Enteromorpha prolifera

Seaweed,as a third generation of biomass energy,has significant potential to replace non-renewable fossil fuels.Among various conversion technologies,hydrothermal liquefaction can effectively convert seaweed into bio-oil.However,most current research on hydrothermal liquefaction products focuses on the oil phase and solid phase,with little attention given to the utilization of the aqueous phase by-product.In this study,the large seaweed Enteromorpha prolifera was selected as the raw material.The aqueous phase containing organic components was prepared through hydrothermal liquefaction at different temperatures,which was then mixed with the polymer polyvinyl alcohol to produce high-value chemical hydrogels.Furthermore,the hydrogels were salted out with Fe3+to explore its influence on the degree of crosslinking.The results show that the mechanical properties of the hydrogel are optimal when the hydrothermal temperature is 160℃,with a maximum fracture stress of 0.55 MPa.After salting-out treatment,the mechanical strength of the hydrogel was further enhanced,with the maximum breaking stress increment by 1.3 times(1.26 MPa).This indicates that the process of adding the aqueous phase to the hydrogel has research potential,and Fe3+can further strengthen the crosslinking process.The results of the present study will provide new insights and methods for aqueous phase valorization.

掌、背侧微型钢板联合固定治疗桡骨远端粉碎性骨折

目的探讨掌、背侧微型钢板联合固定治疗桡骨远端粉碎性骨折的疗效。方法采用掌、背侧微型钢板联合固定治疗20例桡骨远端粉碎性骨折。记录骨折复位情况、术后并发症发生情况、骨折愈合情况、腕关节活动度、影像学检查指标(掌倾角、尺偏角、桡骨高度)。采用DASH评分和Mayo评分评价腕关节功能恢复情况。结果患者均获得随访,时间7~12(9.0±1.3)个月。骨折均解剖复位。术后无切口感染、肌腱断裂、重度神经损伤及骨折复位丢失、继发移位、骨不愈合等并发症发生。骨折均愈合,时间9~14(10.8±1.5)周。末次随访时,腕关节活动度:桡屈患侧小于健侧(P<0.05),背屈、掌屈、尺屈患侧与健侧比较差异均无统计学意义(P>0.05);影像学检查指标:患侧与健侧比较差异均无统计学意义(P>0.05)。末次随访时,DASH评分2~34(10.2±9.6)分;Mayo评分64~98(85.4±12.7)分,优良率16/20。结论掌、背侧微型钢板联合固定治疗桡骨远端粉碎性骨折,能获得满意的骨折复位及稳定的内固定效果,患者能早期进行腕关节锻炼,更利于腕关节功能恢复,且并发症发生率低。

改良Henry入路治疗AO-B与C型桡骨远端骨折疗效观察

目的:探讨改良Henry入路治疗AO-B、C型桡骨远端骨折的临床疗效。方法:回顾分析2021年6月至2022年5月,采用改良Henry入路治疗AO-B、C型桡骨远端骨折患者20例。其中男6例,女14例;年龄35~78岁;左侧8例,右侧12例。记录患者一般资料、骨折愈合时间、术后并发症、末次随访时影像学参数(掌倾角、尺偏角、桡骨高度)、腕关节活动度及前臂旋转范围,Mayo评分评定腕关节功能。结果:所有患者术后通过门诊复诊获得随访,时间12~18(13.3±2.3)个月。骨折均愈合,愈合时间10~16(12.6±2.5)周,无切口愈合不良、感染、医源性正中神经损伤、骨折延迟愈合、不愈合、畸形愈合等并发症的发生。末次随访X线片测量,掌倾角(11.4±4.0)°,尺偏角(20.9±2.2)°,桡骨高度(10.3±1.2)mm;腕关节掌屈(65.3±5.8)°,背伸(60.2±4.2)°,尺偏(37.8±4.1)°,桡偏(27.0±3.7)°;前臂旋前(80.4±4.1)°,旋后(78.6±3.7)°。腕关节功能依据Mayo评分标准评定:优12例,良6例,可2例。结论:改良Henry入路可以更好显示桡骨远端尺掌侧骨折块,尤其适用于复杂双柱桡骨远端骨折的复位。

尺骨远端掌侧成角与腕尺侧疼痛的相关性研究

目的探讨尺骨远端掌侧成角与腕尺侧疼痛的相关性。方法回顾性分析2016年1月至2017年1月因腕尺侧疼痛就诊于联勤保障部队第九八〇医院的患者64例(观察组),选择同期无腕尺侧疼痛症状志愿者64例作为对照组。2组均拍摄双侧腕关节正侧位X线片,通过测量尺骨远端掌侧成角,研究尺骨远端掌侧成角与腕尺侧疼痛的关系。结果观察组双腕尺骨远端掌侧成角差异无统计学意义(P>0.05);观察组与对照组尺骨远端掌侧成角差异无统计学意义(P>0.05);亚组分析显示,观察组尺骨远端掌侧成角170~175°范围的概率为48.44%,对照组为9.38%,2组差异有统计学意义(P<0.05)。结论尺骨远端掌侧成角可能是腕尺侧疼痛的危险因素之一,且角度越小越容易出现腕尺侧疼痛。

随机森林算法预测单纯掌侧钢板内固定术后背侧关节内骨块稳定性及模型构建和验证

目的基于随机森林算法分析桡骨远端骨折患者接受单纯掌侧钢板内固定术后背侧关节内骨块稳定性的影响因素,构建随机森林模型预测术后背侧关节内骨块稳定性风险。方法采用便利抽样法,选取2017年1月至2022年1月于河南煤业(集团)有限责任公司中央医院行单纯掌侧钢板内固定术治疗的320例桡骨远端骨折为研究对象,统计术后背侧关节内骨块稳定性,依据骨块是否移位分为稳定组、非稳定组。收集两组一般资料及骨折、手术相关诊治信息。单因素、多因素logistic回归分析术后背侧关节内骨块稳定性的影响因素。建立随机森林模型,并分析该模型对术后背侧关节内骨块稳定性的预测价值。结果术后12个月内背侧关节内骨块移位发生率为27.22%;C3型骨折、锁定加压钢板内固定、术前骨块总移位距离、骨块横向宽度、骨块横纵比、骨块体积是术后背侧关节内骨块稳定性的影响因素(P<0.05);重要性分析显示影响术后背侧关节内骨块稳定性变量的重要性由高到低的前4位依次为术前骨块总移位距离、锁定加压钢板内固定、骨块体积、骨块横向宽度;随机森林模型预测术后背侧关节内骨块稳定性风险的灵敏度为91.02%,特异度为82.36%。结论基于随机森林算法构建的预测模型对单纯掌侧钢板内固定术后背侧关节内骨块稳定性具有一定预测价值,有助于早期识别高危患者,对背侧钢板的选择具有指导价值。

经旋前方肌下肌骨通道保留旋前方肌内固定治疗桡骨远端骨折

目的探讨经旋前方肌下肌骨通道保留旋前方肌内固定治疗桡骨远端骨折的疗效。方法将100例桡骨远端骨折患者根据是否保留旋前方肌分为对照组(采用倒L形切口切开旋前方肌内固定治疗,54例)和观察组(采用经旋前方肌下肌骨通道保留旋前方肌内固定治疗,46例)。记录骨折复位及愈合情况、疼痛VAS评分、腕关节影像学指标、前臂及腕关节活动度、Gartland-Werley评分。结果患者均获得随访,时间12~20个月。术后X线片显示:骨折均对位对线良好,关节面恢复平整,达到解剖复位。两组骨折均愈合良好,时间2.7~5.5个月。术后6周疼痛VAS评分、前臂旋前及旋后活动度、Gartland-Werley评分观察组均优于对照组(P<0.05);末次随访时前臂旋前活动度观察组大于对照组(P<0.05),前臂旋后活动度、Gartland-Werley评分两组比较差异均无统计学意义(P>0.05)。末次随访时腕关节掌屈、背伸活动度及掌倾角、尺偏角两组比较差异均无统计学意义(P>0.05)。结论经旋前方肌下肌骨通道保留旋前方肌内固定治疗桡骨远端骨折,可缩短患者康复时间,最大程度保留前臂旋前功能,且安全有效。