目的:本研究旨在探讨尺骨背片的大小和固定方式对桡骨远端骨折(DRF)临床结局的影响。
方法:本研究对94例DFR伴侧耳碎片的患者进行了回顾性分析。从2018年10月到2022年11月。平均随访时间为15.5(范围,12-20)个月。患者分为小-(<5%,n=28),中等-(5-15%,n=50),和大-(>15%,n=16)根据通过三维(3D)计算机断层扫描(CT)建模确定的背侧碎片的关节受累情况进行分组。对于术后碎片移位(>2mm)和包括掌侧锁定钢板(VLP)在内的固定方法,也进行了细分。VLP与背侧空心压紧螺钉(VDS)结合,和VLP结合背侧低剖面微型板(VDP)。射线照相参数(掌侧倾斜,径向倾角,和径向高度)和手腕活动范围的功能结果测量,手腕功能(DASH,PRWE),评估并比较两组之间的腕关节疼痛(VAS)。
结果:最终随访时,所有患者均观察到骨折愈合。在接受VDS和VDP治疗的患者中未观察到背鼠碎片移位的实例,并且在小尺寸组中,背鼠碎片移位的发生率为35%(n=8)。中型组21%(n=7),当患者接受VLP治疗时,大型组的比例为7%(n=1)。在小团体中,有和没有背屈限制的患者之间没有发现明显差异(10.6±2.8°,9.1±2.3°,P=0.159),前位限制(9.6±2.1°,8.6±1.7°,P=0.188),DASH(11.5±4.1,10.7±3.2,P=0.562),PRWE(11.9±4.2,10.6±3.6,P=0.425),VAS(1.1±1.1,0.9±1.0,P=0.528)。在中型与大型组合的群体中,背屈限制的功能结局指标(12.5±3.7°,9.8±2.9°,P=0.022),DASH(14.6±5.2,11.4±3.7,P=0.030),PRWE(15.0±4.5,11.3±3.9,P=0.016)在无背侧碎片移位的患者中优于PRWE。在接受VLP治疗的患者中,在背屈限制(9.8±2.5°,10.8±3.5°,9.4±2.5°,P=0.299),前位限制(9.2±1.9°,10.1±2.8°,8.9±1.5°,P=0.200),DASH(11.1±3.5,12.9±4.3,11.1±3.6,P=0.162),PRWE(11.1±3.9,12.8±4.2,10.8±3.9,P=0.188),和VAS(1.0±1.0,1.4±1.1,0.9±0.9,P=0.151)之间的小尺寸,中型,和大型团体。在中等规模的群体中,在背屈限制(10.8±3.5°,9.4±2.2°,9.4±2.4°,P=0.316);前顶受限(10.1±2.8°,8.8±1.9°,9.0±2.5°,P=0.314),DASH(12.9±4.3,10.3±3.7,10.5±3.7,P=0.133),PRWE(12.8±4.2,10.4±3.8,10.6±4.1,P=0.199),VLP亚组间VAS(1.4±1.1,0.8±0.7,1.0±1.1,P=0.201),VDS,和VDP。两组之间的影像学参数没有显着差异。
结论:这项研究表明,当关节受累小于5%时,严格复位和固定背骨碎片可能不是必需的。掌侧锁定钢板(VLP)固定通常可有效治疗桡骨远端骨折,并伴有累及关节面15%以上的背侧碎片。此外,在早期随访中,当背骨碎片累及关节面的5-15%时,使用额外的背侧空心加压螺钉或背侧低调微型钢板可以获得良好的腕关节功能。
OBJECTIVE: This study aimed to investigate the influence of size and fixation options of dorsoulnar fragments on the clinical outcomes of distal radius fractures (DRFs).
METHODS: This retrospective analysis was performed on 94 patients with DFR accompanied by dorsoulnar fragments, spanning the period from October 2018 to November 2022. Mean follow-up was 15.5 (range, 12-20) months. Patients were divided into small- (<5 %, n = 28), middle- (5-15 %, n = 50), and large- (>15 %, n = 16) sized groups according to articular involvement of dorsoulnar fragments determined by three-dimensional (3D) computed tomography (CT) modeling. Subdivision also took place for the presence of postoperative fragment displacement (>2 mm) and fixation methods including volar locking plate (VLP), VLP combined with dorsal hollow compression screw (VDS), and VLP combined with dorsal low-profile mini plate (VDP). The radiographic parameters (volar tilt, radial inclination, and radial height) and functional outcome measures of wrist range of motion, wrist function (DASH, PRWE), and wrist pain (VAS) were evaluated and compared between groups.
RESULTS: Fracture healing was observed in all patients at final follow-up. No instances of dorsoulnar fragment displacement were observed in patients undergoing VDS and VDP treatment and the incidence of the dorsoulnar fragment displacement was 35 % (n = 8) in small-sized group, 21 % (n = 7) in middle-sized group, and 7 % (n = 1) in large-sized group when patients were treated with VLP. In small-sized group, no significant differences were found between patients with and without dorsoulnar fragment displacement in dorsiflexion restriction (10.6 ± 2.8°, 9.1 ± 2.3°, P = 0.159), pronosupination restriction (9.6 ± 2.1°, 8.6 ± 1.7°, P = 0.188), DASH (11.5 ± 4.1, 10.7 ± 3.2, P = 0.562), PRWE (11.9 ± 4.2, 10.6 ± 3.6, P = 0.425), and VAS (1.1 ± 1.1, 0.9 ± 1.0, P = 0.528). In middle-sized combined with large-sized group, the functional outcome measures of dorsiflexion restriction (12.5 ± 3.7°, 9.8 ± 2.9°, P = 0.022), DASH (14.6 ± 5.2, 11.4 ± 3.7, P = 0.030), and PRWE (15.0 ± 4.5, 11.3 ± 3.9, P = 0.016) were superior in patients without dorsoulnar fragment displacement. In patients treated with VLPs, no significant differences were found in dorsiflexion restriction (9.8 ± 2.5°, 10.8 ± 3.5°, 9.4 ± 2.5°, P = 0.299), pronosupination restriction (9.2 ± 1.9°, 10.1 ± 2.8°, 8.9 ± 1.5°, P = 0.200), DASH (11.1 ± 3.5, 12.9 ± 4.3, 11.1 ± 3.6, P = 0.162), PRWE (11.1 ± 3.9, 12.8 ± 4.2, 10.8 ± 3.9, P = 0.188), and VAS (1.0 ± 1.0, 1.4 ± 1.1, 0.9 ± 0.9, P = 0.151) between small-sized, middle-sized, and large-sized groups. In middle-sized group, no significant differences were found in dorsiflexion restriction (10.8 ± 3.5°, 9.4 ± 2.2°, 9.4 ± 2.4°, P = 0.316); pronosupination restriction (10.1 ± 2.8°, 8.8 ± 1.9°, 9.0 ± 2.5°, P = 0.314), DASH (12.9 ± 4.3, 10.3 ± 3.7, 10.5 ± 3.7, P = 0.133), PRWE (12.8 ± 4.2, 10.4 ± 3.8, 10.6 ± 4.1, P = 0.199), and VAS (1.4 ± 1.1, 0.8 ± 0.7, 1.0 ± 1.1, P = 0.201) between subgroups of VLP, VDS, and VDP. No significant differences were found in radiographic parameters between all groups compared.
CONCLUSIONS: This study indicated that the strict reduction and fixation of a dorsoulnar fragment might be not essential when its articular involvement was less than 5 %. The volar locking plate (VLP) fixation was commonly effective in treating distal radius fractures accompanied by a dorsoulnar fragment involving over 15 % of the articular surface. Additionally, the use of an additional dorsal hollow compression screw or a dorsal low-profile mini plate can get good wrist function in the early-term follow-up when the dorsoulnar fragment involve 5-15 % of the articular surface.