目的:闭合复位结合外固定是治疗成人桡骨远端骨折的常用方法。尽管如此,外固定后再次移位的可能性仍然存在。分析影响成人桡骨远端骨折非手术治疗后再移位的因素对于预防再移位和进行预后评估至关重要。
方法:对天津医院中西医结合骨伤复位室接受非手术治疗的884例桡骨远端骨折患者进行回顾性分析,天津,中国,2019年7月至2022年12月。患者分为两组,即流离失所者和非流离失所者,基于射线照相结果。检查了影响骨折再移位的因素,包括性,年龄,侧面,AO/OTA类型,外固定,以及减少前和立即减少时的影像学结果。采用Logistic回归分析确定骨折再移位的危险因素,并构建ROC曲线。
结果:在884名患者中,563(63.69%)在骨折复位后发生了再移位。两组在性别方面差异无统计学意义(p>0.05)。外固定方法,和手掌倾斜角度在预减少和立即减少,虽然在年龄上观察到显著差异(p<0.05),侧面,AO/OTA类型,和径向倾角,径向长度,减少前和立即减少时尺骨变异的影像学结果。多因素Logistic回归分析显示,年龄(比值比[OR]=1.027,p<0.001),AO/OTA类型(OR=2.327,p=0.005),减少前的尺骨方差(OR=1.142,p=0.048),立即复位时的尺骨方差(OR=1.685,p<0.001)是与成人桡骨远端骨折非手术治疗后再移位相关的重要因素(p<0.05)。对于年龄≥60岁的患者,放射学结局缺失的数量与年龄呈正相关.受试者工作特性曲线表明年龄≥65.5岁,预复位时尺骨方差>3.26mm,即刻复位时尺骨方差>2.055mm是骨折再移位的高危因素。
结论:非手术治疗桡骨远端骨折的再移位率较高。年龄,AO/OTA类型,预还原,即刻复位尺骨方差是预测骨折再移位的关键因素。
OBJECTIVE: Closed reduction combined with external fixation is a frequently utilized approach for treating distal radial fractures in adults. Nonetheless, the potential for re-displacement following external fixation remains. Analyzing the factors influencing re-displacement after nonsurgical treatment of distal radial fractures in adults is vital for preventing re-displacement and making prognostic assessments.
METHODS: A retrospective analysis was performed on 884 patients who underwent nonsurgical treatment for distal radius fractures in the reduction room of the Orthopedics and Traumatology Department of Integrated Traditional Chinese and Western Medicine at Tianjin Hospital, Tianjin, China, between July 2019 and December 2022. Patients were categorized into two groups, namely displaced and nondisplaced, based on radiographic outcomes. Factors affecting fracture re-displacement were examined, including sex, age, side, AO/OTA type, external fixation, and radiographic outcomes at pre-reduction and immediate reduction. Logistic regression analysis was employed to identify the risk factors for fracture re-displacement, and ROC curves were constructed.
RESULTS: Among the 884 patients, 563 (63.69%) experienced re-displacement after fracture reduction. There were no statistically significant differences (p > 0.05) between the two groups in terms of gender, external fixation method, and palmar tilt angle at pre-reduction and immediate reduction, while significant differences (p < 0.05) were observed in age, side, AO/OTA type, and radial inclination, radial length, and radiographic outcomes of ulnar variance at pre-reduction and immediate reduction. Multifactorial logistic regression analysis revealed that age (odds ratio [OR] = 1.027, p < 0.001), AO/OTA type (OR = 2.327, p = 0.005), ulnar variance at pre-reduction (OR = 1.142, p = 0.048), and ulnar variance at immediate reduction (OR = 1.685, p < 0.001) were significant factors (p < 0.05) associated with re-displacement following nonoperative treatment of adult distal radius fractures. For patients aged ≥60 years, the amount of missing radiographic outcomes was positively correlated with age. The receiver operating characteristic curve demonstrated that age ≥65.5 years, ulnar variance >3.26 mm at pre-reduction, and ulnar variance >2.055 mm at immediate reduction were high-risk factors for fracture re-displacement.
CONCLUSIONS: Nonsurgical treatment of distal radius fractures exhibits a higher rate of re-displacement. Age, AO/OTA type, pre-reduction, and immediate reduction ulnar variance are key factors predicting fracture re-displacement.