目的:探讨掌侧锁定钢板(VLP)和“戳复位”技术治疗桡骨远端骨折(DRF)伴尺骨背侧碎片移位的临床和放射学结果。
方法:在2014年1月至2019年1月之间,进行了78例VLP治疗的单侧尺骨背侧片段移位(AOC3型)的DRF。根据尺骨背侧碎片的缩小技术,将患者分为常规复位(CRG)组(33例,14男19女,平均年龄57.2±12.1岁)和“戳减少”(PRG)组(45例患者,11名男性和34名女性,平均年龄60.1±12.4岁)。根据AO分类,CPG组C3.121例,C3.212例,PRG组27例C3.1和18例C3.2。从电子病历系统中提取临床和影像学数据。对这些数据进行了临床结果审查(运动范围,握力),放射学结果(掌侧倾斜,径向倾角,径向高度,关节表面的台阶),术后并发症。最终的功能恢复通过手臂的残疾来评估,肩膀,和手(DASH)得分。
结果:平均随访时间为27个月(12至56个月)。两组平均手术时间和术中出血量比较差异无统计学意义(p>0.05)。术后CT检查显示,CPG组关节面台阶(0.8±0.3mm)大于PRG组(0.5±0.2mm)(p<0.001)。DASH评分在组间无显著差异(CRG为26.1±4.6,PRG为24.7±4.0,p>0.05)术后3个月。术后6个月和12个月,PRG组DASH评分(11.8±2.5和10.4±2.0)优于CRG组(13.6±2.7和12.2±2.5)(p=0.004,p=0.001).术后12个月,两组间腕关节活动范围无显著差异(p>0.05).两组放射学参数比较差异无统计学意义(p>0.05)。CRG组(7/33)的并发症发生率高于PRG组(2/45)(p=0.009)。
结论:“戳减少”技术是减少DRF中尺骨背侧碎片的明智选择。这种创新技术可以有效地恢复桡骨关节的光滑度,尺骨背侧碎片可以与掌侧板有效结合固定。
OBJECTIVE: To investigate the clinical and radiological outcomes of distal radius fractures (DRFs) with displaced dorsal ulnar fragments treated with volar locking plate (VLP) and the \"poking reduction\" technique.
METHODS: Between January 2014 and January 2019, 78 unilateral DRFs with displaced dorsal ulnar fragment (AO type C3) treated with VLP were conducted. According to the reduction technique of the dorsal ulnar fragment, the patients were divided into the conventional reduction (CRG) group (33 patients, 14 males and 19 females, mean age 57.2 ± 12.1 years old) and the \"poking reduction\" (PRG) group (45 patients, 11 males and 34 females, mean age 60.1 ± 12.4 years old). According to the AO classification, there were 21 cases of C3.1 and 12 of C3.2 in the CPG group, 27 cases of C3.1 and 18 of C3.2 in the PRG group. Clinical and radiographic data were extracted from the electronic medical record system. These data were reviewed for clinical outcomes (range of motion, grip strength), radiological outcomes (volar tilt, radial inclination, radial height, step of articular surface), and postoperative complications. The final functional recovery was evaluated by the disabilities of the arm, shoulder, and hand (DASH) score.
RESULTS: The mean duration of follow-up was 27 months (range from 12 to 56). The average operation time and intraoperative blood loss did not significantly differ between groups (p > 0.05). Postoperative CT examination showed that the step of articular surface in CPG group (0.8 ± 0.3 mm) was larger than that in PRG group (0.5 ± 0.2 mm) (p < 0.001). The DASH score did not significantly differ between groups (26.1 ± 4.6 in CRG and 24.7 ± 4.0 in PRG, p > 0.05) at 3 months postoperatively. At 6 months and 12 months postoperatively, the DASH score was better in PRG group (11.8 ± 2.5 and 10.4 ± 2.0) than in CRG group (13.6 ± 2.7 and 12.2 ± 2.5) (p = 0.004, p = 0.001, respectively). At 12 months postoperatively, wrist range of motion did not significantly differ between groups (p > 0.05). There was no significant difference in radiological parameters between the two groups (p > 0.05). The incidence of complications was higher in the CRG group (7/33) than in the PRG group (2/45) (p = 0.009).
CONCLUSIONS: The \"poking reduction\" technique is a wise option for reduction of dorsal ulnar fragment in DRFs. This innovative technique could restore smoothness of the radiocarpal joint effectively, and the dorsal ulnar fragment could be fixed effectively combined with the volar plate.