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.

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.

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.

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。

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。

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。

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。

改良Henry入路保留旋前方肌掌侧锁定钢板内固定治疗桡骨远端骨折疗效分析

目的探讨改良Henry入路保留旋前方肌掌侧锁定钢板内固定治疗桡骨远端骨折的临床疗效。方法选取2018年1月至2022年1月肇庆市中医院收治的84例桡骨远端骨折患者作为研究对象,按照不同手术方法将其分为观察组(42例)和对照组(42例),观察组患者采用改良Henry入路保留旋前方肌掌侧锁定钢板内固定治疗,对照组患者采用改良Henry入路离断旋前方肌掌侧锁定钢板内固定治疗,对比观察两组患者上肢功能障碍评定量表(Quick-DASH)评分、腕关节功能患者自行评估量表(PRWE)评分、Mayo腕关节功能评分(简称Mayo评分)、视觉模拟评分法(VAS)评分及不良事件发生情况。结果术后1、6个月,观察组患者Quick-DASH、PRWE及VAS评分均明显低于对照组,Mayo评分明显高于对照组(术后1个月:t=3293、4123、2902、2366,P=0002、P<0001、P=0005、P=0020;术后6个月:t=4877、4136、2139、2695,P<0001、P<0001、P=0035、P=0009);观察组患者术后不良事件发生率为714%,明显低于对照组患者的术后不良事件发生率2381%(χ^(2)=4459,P=0035)。结论桡骨远端骨折采用改良Henry入路保留旋前方肌掌侧锁定钢板内固定治疗更能明显减轻患者疼痛,促进上肢功能及腕关节功能恢复,降低术后不良事件发生风险。

掌侧万向锁定接骨钢板与外固定夹板治疗桡骨远端骨折的对比研究

目的:探讨掌侧万向锁定接骨钢板与外固定夹板治疗桡骨远端骨折对骨折部位关节功能的影响及安全性。方法:选取2020年1月-2023年1月本院收治的80例桡骨远端骨折的患者,根据手术方法的不同,将其分为观察组和对照组,观察组(n=42)使用掌侧万向锁定接骨钢板治疗,对照组(n=38)使用外固定夹板治疗,观察并比较两组骨折线消失、骨痂出现时间,术前、术后4 w、术后8 w腕关节尺偏角、掌倾角,腕关节活动度(屈伸度、旋转度、内收外展活动度)以及并发症发生情况。结果:观察组骨痂出现时间、骨折线消失时间均早于对照组(P<0.05);两组术后3 m腕关节尺偏角、掌倾角均优于术前(P<0.05);两组术后3 m腕关节尺屈伸度、旋转度、内收外展活动度均优于术前,且观察组术后3 m腕关节屈伸度、旋转度、内收外展活动度优于对照组(P<0.05)。结论:与外固定夹板相比,桡骨远端骨折患者选择掌侧万向锁定接骨钢板治疗,在改善患者腕关节,缩短骨折线消失、骨痂出现时间方面优势更佳。

直血管钳背侧撬拨辅助掌侧入路内固定治疗桡骨远端C型骨折的临床疗效

目的探讨直血管钳背侧撬拨辅助掌侧入路内固定治疗桡骨远端C型骨折的临床疗效。方法回顾性分析2019年6月-2021年1月收治的桡骨远端粉碎性骨折手术患者32例病例资料,纳入病例经腕关节DR及CT检查提示桡骨远端骨折,国际内固定研究协会(AO)分型为C型骨折,且为外伤导致,并为单侧损伤。术后采用Gartland-Werley腕关节功能评分对患侧腕关节功能进行评估。结果术后均随访10~16个月,平均13.2个月,未出现切口感染、骨髓炎等并发症,患侧桡骨远端掌倾角、尺偏角及桡骨高度未发生改变。末次随访Gartland-Werley腕关节功能评分标准显示:优23例,良7例,可2例,优良率93%。结论直血管钳背侧撬拨辅助掌侧入路内固定治疗桡骨远端粉碎性骨折在恢复桡骨高度、掌倾角和尺偏角中有很大优势,临床效果满意,有利于患者快速康复。

保留旋前方肌完整性联合掌侧锁定钢板内固定治疗桡骨远端骨折

背景:桡骨远端骨折最常用入路是传统Henry入路,但术中需切断旋前方肌,修复旋前方肌失败会带来一系列并发症。目的:探讨保留旋前方肌联合掌侧锁定钢板治疗桡骨远端骨折的临床效果。方法:回顾性分组对照分析64例桡骨远端骨折患者的临床资料,其中采取保留旋前方肌完整性方法的为改良组32例,按AO分型,23-B1型8例,23-B2型7例,23-B3例7例,23-C1型6例,23-C2型4例;采取传统Henry入路切断旋前方肌方法的为传统组32例,其中23-B1型7例,23-B2型9例,23-B3型3例,23-C1型6例,23-C2型7例。观察两组患者术后内固定、骨折愈合、术后并发症等情况,比较两组术后腕部疼痛目测类比评分(VAS),分别采用Dienst关节评分标准评估患者腕关节功能、影像学指标评估手术疗效。结果与结论:①改良组患者的平均手术时间及术中平均失血量均显著少于传统组(Z=-6.77,P<0.01;Z=-5.41,P<0.01);②改良组患者骨折平均愈合时间短于传统组(Z=-2.08,P<0.05);③术后12个月改良组和传统组患者腕关节功能优良率分别为94%(30/32)、88%(28/32),差异无显著性意义(χ2=0.767,P=0.682);④术后3 d及1,3个月两组患者腕关节正侧位X射线片显示,桡骨高度、掌倾角、尺偏角相比差异均无显著性意义(P>0.05);⑤术后1周及1,3个月改良组患者目测类比评分均低于传统组(P<0.05),而术后12个月两组患者目测类比评分相比差异无显著性意义(P>0.05);⑥两组患者术后均未出现创伤性关节炎;传统组有2例腕管综合(Ⅱ期取出内固定装置症状缓解);⑦结果说明,保留旋前方肌的改良Henry方法在后期旋前角度和疼痛上没有显著优势;然而,术中可以缩短手术时间,减少术中出血,减少术后早期疼痛,促进早期活动。