目的:记录50岁及以上完全孤立的桡骨远端骨折(DRF)后9周和3、6和12个月时临床(腕关节运动和握力)测量值和患者腕关节评估(PRWE)评分的变化。流离失所,和通过封闭和/或开放还原治疗的低能量DRF,并将这些结果与其影像学结果相关联。
方法:在这项回顾性单机构队列研究中,从2007年12月至2018年9月前瞻性收集DRF后患者的临床测量值和PRWE评分,并根据他们的掌侧/背侧倾斜的最终影像学值进行分层,尺骨方差,和径向倾斜。
结果:在确定的1,319名女性中,1,126(85%)接受了非手术治疗,手术治疗193例(15%)。12个月时,患者平均恢复(受伤和未受伤的两侧值之比)为96%内旋,95%扩展,91%的仰卧起坐,81%屈曲,和80%(77%的非显性,85%占优势)的握力。平均PRWE评分在第9周为39.5,12个月为14.4,54%的患者评分<10,13%的患者评分为0。平均掌侧/背侧倾斜,尺骨方差,非手术治疗的患者的径向倾角值为1.4°背侧,+3.9mm,18.0°,分别。手术治疗的患者的类似值为6°,+2.6mm,22°,分别。掌侧倾角≥25°,背侧倾斜>10°,尺骨方差>+7.5mm,和径向倾角≤13°是阈值,超过该阈值时,运动和握力降低和/或PRWE评分增加.总的来说,老年患者的残余畸形较多,接受手术的可能性较小.
结论:一般来说,对于影像学检查结果在确定的可接受骨折复位阈值内的患者,结局令人满意.结果对放射学结果超过这些阈值的患者明显不利;对于这些患者,应考虑早期手术干预.低能量DRF应促进骨密度调查。
方法:治疗2b。
OBJECTIVE: To document the change of clinical (wrist motion and grip strength) measurements and Patient-Rated Wrist Evaluation (PRWE) scores at 9 weeks and 3, 6, and 12 months after distal radius fracture (DRF) in women 50 years and older with exclusively isolated, displaced, and low-energy DRFs treated by either closed and/or open reduction and to relate these outcomes to their radiographic results.
METHODS: In this retrospective single-institution cohort study, patients\' post-DRF clinical measurements and PRWE scores were prospectively collected from December 2007 through September 2018 and stratified according to their final radiographic values of volar/dorsal tilt, ulnar variance, and radial inclination.
RESULTS: Of the 1,319 women identified, 1,126 (85%) were treated nonsurgically, and 193 (15%) were treated operatively. At 12 months, patients averaged restoration (ratio of injured and uninjured sides\' values) of 96% pronation, 95% extension, 91% supination, 81% flexion, and 80% (77% nondominant, 85% dominant) grip strength. The mean PRWE score was 39.5 at week 9 and 14.4 at 12 months with 54% of patients scoring <10 and 13% scoring zero. The mean volar/dorsal tilt, ulnar variance, and radial inclination values in those treated nonsurgically were 1.4° dorsal, +3.9 mm, and 18.0°, respectively. Analogous values in patients treated surgically were 6° volar, +2.6 mm, and 22°, respectively. Volar tilt ≥25°, dorsal tilt >10°, ulnar variance >+7.5 mm, and radial inclination ≤13° were thresholds beyond which motion and grip strength were reduced and/or PRWE scores increased. In general, older patients experienced more residual deformity and were less likely to have undergone surgery.
CONCLUSIONS: Generally, outcomes were satisfactory for patients with radiographic results within identified thresholds for acceptable fracture reduction. Outcomes were significantly less favorable for patients with radiographic results beyond these thresholds; for these patients, early surgical intervention should be considered. Low-energy DRFs should prompt bone density investigation.
METHODS: Therapeutic 2b.