中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (27): 4374-4378.doi: 10.12307/2021.199

• 骨科植入物 orthopedic implant • 上一篇    下一篇

桡骨远端骨折掌侧钢板内固定后关节僵硬的危险因素

程文静，丁国正，谢家兵，王  林   

  1. 皖南医学院第一附属医院，安徽省芜湖市   241000
  • 收稿日期:2020-10-24 修回日期:2020-10-29 接受日期:2020-12-07 出版日期:2021-09-28 发布日期:2021-04-10
  • 通讯作者: 丁国正，主任医师，皖南医学院第一附属医院 ，安徽省芜湖市 241000
  • 作者简介:程文静，男，1996年生，安徽省合肥市人，汉族，皖南医学院第一附属医院创伤骨科在读硕士，主要从事四肢创伤骨折与修复研究。
  • 基金资助:
    安徽省自然科学基金项目 (1708085QH209)，项目负责人：王林

Risk factors for joint stiffness after volar plate fixation for distal radius fractures

Cheng Wenjing, Ding Guozheng, Xie Jiabing, Wang Lin   

  1. The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
  • Received:2020-10-24 Revised:2020-10-29 Accepted:2020-12-07 Online:2021-09-28 Published:2021-04-10
  • Contact: Ding Guozheng, Chief physician, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
  • About author:Cheng Wenjing, Master candidate, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
  • Supported by:
    the Natural Science Foundation of Anhui Province, No. 1708085QH209 (to WL)

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摘要：

文题释义：
掌侧锁定钢板：由锁定接骨板和锁定加压螺钉组成，具有较高的稳定性以及优良的组织相容性。
桡骨远端骨折：是一种最常见的前臂骨折，目前国内手术治疗主要为掌侧钢板固定，如治疗不当，则可能引起创伤性关节炎以及关节僵硬等后遗症。

背景：桡骨远端骨折掌侧钢板内固定治疗已被广泛认可，而目前对于掌侧钢板固定后腕关节僵硬及危险因素的研究尚不明确。
目的：了解桡骨远端骨折掌侧钢板内固定后桡腕关节僵硬情况，并探讨导致关节僵硬的相关危险因素。
方法：对2016年5月至2019年7月在皖南医学院第一附属医院接受掌侧钢板内固定治疗的125例桡骨远端骨折患者资料进行回顾性分析。对患者一般资料、术后随访资料进行统计学分析。评估腕关节术前肿胀程度；从术前的X射线片中收集骨折类型和伴尺骨茎突骨折，在术后第12个月的随访中通过X射线片测量掌倾角、尺偏角和桡骨高度；并用量角器评估术后桡腕关节的运动情况，如果屈伸运动范围不超过对侧的一半，则认为存在桡腕关节僵硬。 经过单变量分析，P < 0.2提示为关节僵硬的潜在危险因素，然后纳入多变量Logistic回归模型。
结果与结论：①在随访中约有1/3的桡骨远端骨折患者在掌侧锁定钢板固定后出现关节僵硬；②单因素分析示，年龄(P=0.13)、骨质疏松症(P=0.02)、术前肿胀(P=0.01)、骨折类型(AO分型)(P=0.01)、关节内骨折(P=0.01)、术后掌倾角(P=0.05)、术后外固定的使用(P=0.19)是桡骨远端骨折掌侧钢板内固定后关节僵硬潜在危险因素；③进一步Logistic回归分析示，骨折类型(AO分型)(OR=1.21，95%CI：0.98-1.56)、关节内骨折(OR=1.17，95%CI：1.06-1.97)、术前肿胀程度(OR=1.28，95%CI：1.12-1.85)、骨质疏松症(OR=1.32，95% CI：0.86-1.77)和术后掌倾角(OR=1.46，95%CI：1.01-1.89)是桡骨远端骨折掌侧钢板内固定后关节僵硬的独立危险因素；④提示对于存在此类危险因素的患者，术前充分评估，做出准确的术前计划以及术后随访过程中及时适当的预防治疗措施是值得重视的。
https://orcid.org/0000-0002-6138-594X (程文静) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 桡骨远端骨折, 掌侧, 内固定, 腕关节, 僵硬, 术前肿胀

Abstract: BACKGROUND: The treatment of volar plate fixation for distal radius fractures has been widely recognized. However, the current research on wrist stiffness and risk factors after volar plate fixation is still unclear.  
OBJECTIVE: To understand the stiffness of the radiocarpal joint after distal radius fractures and explore the related risk factors for joint stiffness.
METHODS:  A retrospective analysis was conducted in 125 patients with distal radius fractures who underwent surgical volar plate treatment in The First Affiliated Hospital of Wannan Medical College from May 2016 to July 2019. The general data of the patients and postoperative follow-up data were statistically analyzed. The degree of swelling of wrist joint before operation was evaluated. Fracture types and ulnar styloid process fractures were collected from preoperative X-ray films. Palmar inclination, ulnar declination and radial height were measured by X-ray films during the follow-up of 12 months after operation. The motion of radial wrist joint after operation was evaluated by goniometer. If the range of motion of flexion and extension did not exceed half of the contralateral, it was considered that there was radial wrist joint stiffness. Univariate analysis showed that P < 0.2 was a potential risk factor for joint stiffness, and then multivariate Logistic regression model was used.  
RESULTS AND CONCLUSION: (1) During follow-up, about 1/3 of distal radius fractures patients developed radiocarpal joint stiffness after volar locking plate fixation. (2) Univariate analysis showed that age (P=0.13), osteoporosis (P=0.02), preoperative swelling (P=0.01), fracture type (AO classification) (P=0.01), intra-articular fractures (P=0.01), postoperative palm inclination (P=0.05), and postoperative external fixation (P =0.19) were potential risk factors for joint stiffness after volar plate internal fixation for distal radius fractures. (3) Further Logistic regression analysis showed that fracture type (AO classification) (OR=1.21, 95%CI:0.98-1.56), intra-articular fractures (OR=1.17, 95%CI:1.06-1.97), preoperative swelling (OR=1.28; 95%CI: 1.12-1.85), osteoporosis (OR=1.32, 95%CI:0.86-1.77) and postoperative palm inclination (OR=1.46, 95%CI:1.01-1.89) were the independent risk factors for joint stiffness after volar plate internal fixation of distal radius fractures. (4) It is indicated that for patients with such risk factors, adequate preoperative evaluation, accurate preoperative planning, and timely and appropriate preventive treatment measures during postoperative follow-up are worthy of attention by orthopedic surgeons.

Key words: distal radius fractures, volar, internal fixation, wrist joint, stiffness, preoperative swelling

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