背景:对于65岁以上老年患者桡骨远端骨折(DRF)的最佳手术治疗缺乏共识,本研究的目的是通过一项回顾性队列研究,比较克氏针外固定架(EF)和掌侧锁定钢板(VLP)治疗DRF的疗效.我们假设两种方法在总体并发症和功能恢复方面没有显着差异。
方法:我们回顾性分析了2019年至2022年间接受C型DRF手术治疗的62例65岁以上患者。根据不同的治疗方法,分为EF组和VLP组.一般数据,住院数据,并记录随访期间的术后并发症。手术前的X光片,手术后,在最后的随访中进行了分析,和手腕运动范围的结果,Gartland-Werley腕关节评分,术后6个月对两组患者进行DASH评分。
结果:30例患者行闭合复位外固定联合克氏针固定,32例行切开复位VLP固定术。EF组手术时间明显缩短,术中失血,受伤到手术时间,和住院时间与VLP组相比(均p<0.001)。在最后一次随访中,VLP组的影像学参数(尺骨方差和桡骨倾角)和腕关节功能(腕关节背屈和前臂旋后)优于EF组(分别为p=0.04,p=0.01,p=0.001,p=0.02).然而,总体Gartland-Werley腕关节评分无显著差异,DASH得分,两组患者术后并发症发生率(分别为p=0.31,p=0.25,p=0.47)。
结论:对于65岁及以上的C型桡骨远端骨折(DRF)患者,VLP和克氏针外固定短期内可产生相当的功能结果和并发症发生率。然而,VLP允许恢复更好的放射学参数。
BACKGROUND: ue to the lack of consensus on the optimal surgical treatment for distal radius fractures (DRF) in elderly patients over 65 years old, the purpose of this study was to compare the efficacy of external fixation (EF) with Kirschner wires and volar locking plate (VLP) in the treatment of DRF through a retrospective cohort study. We hypothesized that there would be no significant difference in overall complications and functional recovery between the two methods.
METHODS: We retrospectively analyzed 62 patients over 65 years old who underwent surgical treatment for C-type DRF between 2019 and 2022. Based on the different treatment methods, they were divided into the EF group and the VLP group. General data, inpatient data, and postoperative complications during follow-up were recorded. The X-ray images before surgery, after surgery, and at the last follow-up were analyzed, and the results of wrist motion range, Gartland-Werley wrist joint score, and DASH score were evaluated 6 months after surgery for both groups.
RESULTS: Thirty patients underwent closed reduction and external fixation combined with Kirschner wire fixation, while 32 underwent open reduction and VLP fixation. The EF group had significantly shorter operation time, intraoperative blood loss, injury-to-surgery time, and hospital stay compared to the VLP group (all p < 0.001). At the last follow-up, the radiographic parameters (ulnar variance and radial inclination) and wrist joint function (wrist dorsiflexion and forearm supination) were better in the VLP group than in the EF group (p = 0.04, p = 0.01, p = 0.001, p = 0.02, respectively). However, there was no significant difference in overall Gartland-Werley wrist joint score, DASH score, and incidence of postoperative complications between the two groups (p = 0.31, p = 0.25, p = 0.47, respectively).
CONCLUSIONS: For patients aged 65 and above with distal radius fractures (DRF) of type C, VLP and external fixation with Kirschner wires yield comparable functional outcome and complications rate at the short term. However, VLP allowed restoration of better radiological parameters.