Adjustable and ordinary locking compression plates for the repair of osteoporotic distal radius fractures: comparison of radial length and wrist function recovery

doi:10.3969/j.issn.2095-4344.2015.04.016

Abstract

Abstract:

BACKGROUND: Locking compression plate in the treatment of osteoporotic distal radius fractures has achieved good results, but the changes in anatomic parameters of the distal radius after fixation with different kinds of plates remain unclear.

OBJECTIVE: To investigate the clinical outcomes of the adjustable locking compression plate for treatment of osteoporotic distal radius fractures by comparing with the ordinary locking compression plate.

METHODS: A total of 38 patients with osteoporotic distal radius fractures, who were treated in the Department of Orthopedics, Changzhou TCM Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to January 2014, were retrospectively analyzed. According to the fixation schemes, the patients were divided into adjustable locking compression plate group (n=22) and ordinary locking compression plate group (n=16). Fractures were assessed by the AO type, and all incisions were from palm side. The volar tilt, radial inclination, and radial length were recorded and compared between the two groups after surgery and during final follow-up. Wrist function was assessed according to Denis Standard.

RESULTS AND CONCLUSION: All patients were followed up from 5-26 months. All the patients got bone union at an average of 12.3 weeks (range from 9-16 weeks). The volar tilt was 10.6° and 11.3°, and the radial inclination was 21.1° and 19.2° in average instantly after operation, respectively in two groups. At the latest follow up, the volar tilt was 8.5° and 8.5°, and the radial inclination was 17.9° and 15.8° in average, respectively, which did not show significant differences (P > 0.05). The radial shortening values were 0.5 mm and 1.1 mm instantly after operation in two groups. At the latest follow up, the radial shortening values were 0.9 mm and 1.4 mm during final follow-up in the two groups, which exhibited significant differences (P < 0.05). According to Dienst assessment, in adjustable locking compression plate group, 16 cases were excellent, and 6 were good. In ordinary locking compression plate group, 11 cases were excellent, and 5 were good. There was no statistical difference between the two groups (P > 0.05). These results confirmed that the adjustable locking compression plate can obtain good volar tilt, radial inclination and wrist function in treating the osteoporotic distal radius fractures. Compared to the ordinary locking compression plate, it has better restoration of the radial length, which can be maintained during the follow up.

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

全文链接：

Key words: Radius, Fractures, Bone, Osteoporotic Fractures, Internal Fixators, Follow-Up Studies

CLC Number:

R318

Wang Bin, Gao Yi, Xu Jian-da, Xie Zi-kang, Shen Peng-fei, Zheng Chong, Qu Yu-xing. Adjustable and ordinary locking compression plates for the repair of osteoporotic distal radius fractures: comparison of radial length and wrist function recovery[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(4): 584-589.

Figures/Tables 2

2.1 参与者数量分析按意向性处理，纳入38例女性骨质疏松性桡骨远端骨折患者，分为两组，可撑开锁定钢板组22例，普通锁定钢板组16例。全部进入结果分析，无脱落。两组患者分组流程图见图2。 2.2 基线资料比较两组患者术前一般资料比较差异无显著性意义，资料可比性好(见表1)。 2.3 术后随访X射线测量指标及腕关节功能比较所有患者均获随访，随访时间5-26个月。所有患者均获得骨性愈合，愈合时间为9-16周，平均12.3周。内固定后两组掌倾角均值分别为10.6°和11.3°，尺偏角均值分别为21.1°和19.2°；随访末两组掌倾角均值分别为8.5°和8.5°，尺偏角均值分别为17.9°和15.8°，差异均无显著性意义。内固定后两组桡骨短缩均值分别为0.5 mm和 1.1 mm，差异有显著性意义(P < 0.05)，可撑开组较普通组更好的恢复了桡骨长度。随访末，两组桡骨短缩均值分别为0.9 mm和1.4 mm，差异有显著性意义(P < 0.05)，可撑开组较普通组最终获得了更好的桡骨长度。内固定后Dienst功能评估：可撑开组优16例，良6例；普通组优11例，良5例，两组比较，差异无显著性意义(见表2)。 2.4 典型病例病例1：女性患者，67岁，术前尺偏角5°，掌倾角-23°，桡骨短缩3 mm；运用可撑开锁定钢板修复，术后第2天尺偏角20°，掌倾角6°，桡骨短缩0 mm；内固定取出后尺偏角20°，掌倾角5°，桡骨短缩0 mm (见图3)。病例2：女性患者，65岁，术前尺偏角5°，掌倾角-5°，桡骨短缩1 mm；运用普通锁定钢板修复，术后第2天尺偏角21°，掌倾角7°，桡骨短缩1 mm；内固定取出后尺偏角18°，掌倾角7°，桡骨短缩2 mm(见图4)。 2.5 不良事件本组患者术后均未出现神经、血管损伤、感染、骨不连、钢板断裂等并发症。"

References

[1] 高天君,杨达宇.比较切开复位内固定和石膏固定治疗老年骨质疏松性桡骨远端骨折对患肢继发性骨质疏松和关节功能的影响[J].中国骨质疏松杂志,2012,18(3):245-247.
[2] 庞启雄,张朝驹,白红军.切开复位内固定以及手法复位石膏外固定法在治疗老年骨质疏松性桡骨远端骨折效果及其对骨质疏松的影响评价[J].海南医学院学报,2013,19(11):1562-1565.
[3] 姜保国.桡骨远端骨折的治疗[J].中华创伤骨科杂志,2006,8(3): 236-239.
[4] Arora R, Lutz M, Deml C, et al. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am. 2011;93(23):2146-53
[5] 谭加群,李建赤,梁江声,等.锁定加压钢板治疗骨质疏松性桡骨远端骨折[J].中国骨质疏松杂志,2010,16(3):194-196.
[6] 张屹,杨拓,李辉,等.掌侧与背侧入路钢板置入固定修复桡骨远端骨折并发症的Meta分析[J].中国组织工程研究,2014,18(22): 3560-3566.
[7] Clayton RA, Gaston MS, Ralston SH, et al. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009;91(3): 613-619.
[8] 安宝泉,杨玉平,苏恩亮,等.非手术治疗Colles骨折桡骨长度丢失的研究[J].中国骨与关节损伤杂志, 2012, 27(11): 1042-1042.
[9] 李夏,王秋根.桡骨远端骨折手术与非手术治疗[J].国际骨科学杂志, 2013,34(1):23-25.
[10] Mudgal CS, Jupiter JB. Plate fixation of osteoporotic fractures of the distal radius. J Orthop Trauma. 2008;22(8):106-115.
[11] 陈长青,陈蕊,伦保国,等.两种固定方法治疗桡骨远端不稳定骨折40例效果比较[J].解放军医药杂志,2013,25(3):22-24.
[12] 张文才,阳晟,程英雄,等.掌侧锁定加压钢板治疗桡骨不稳定远端骨折的回顾性研究[J].中国骨与关节损伤,2010,25(5):405-407.
[13] 金建强,张骏,陆逸庭.等.解剖型桡骨远端掌侧锁定接骨板治疗老年桡骨远端骨折[J].中医正骨, 2013,25(12):66-68.
[14] Dahl WJ, Nassab PF, Burgess KM, et al. Biomechanical comparision of different volar fracture fixation plates under dynamic loading. J Hand Surg Am. 2012;37(7):1381-1387.
[15] Rhee PC, Dennison DG, Kakar S. Avoiding and treating perioperative complications of distal radius fractures. Hand Clin. 2012;28(2):185-198.
[16] Demirbas ER, Ugras AA, Kaya I. Volar plate fixation of distal radius fractures. Ulus Travma Acil Cerrahi Derg, 2012;18(2): 162-166.
[17] 舒敏锐,李刚,袁晓军,等.锁定钢板内固定结合自体植骨治疗老年桡骨远端骨质疏松性骨折的效果观察[J].中国当代医药,2014, 21(4): 164-165.
[18] Tarallo L, Adani R, Mugnai R, et al. The treatment of distal radius articular fractures of C1-C2 type with DVR plate:analysis of 40cases. Musculoskelet Surg. 2011;95(3):225-230.
[19] 张智海,刘忠厚,李娜,等.中国人骨质疏松症诊断标准专家共识(第三稿•2014版) [J].中国骨质疏松杂志,2014,20(9): 1007-1010.
[20] Qu Y, Xu J, Jiang T, et al. Unstable Distal Radius Fractures: Restoration of the Radial Length with Use of Special Palmar Fixed-angle Plate. Handchir Mikrochir Plast Chir. 2013; 45(1): 1-5.
[21] Dienst M,Woxasek GE,Seligson D. Dynamic external fixation for distal fractures. Clin Orthop. 1997;338(1):160.
[22] 苑文杰. 锁定钢板治疗桡骨远端骨折36例疗效观察[J]. 临床和实验医学杂志, 2012,11(15):1232-1233.
[23] 刘勇,瞿懿,孙振中,等.影响桡骨远端骨折治疗效果的多因素分析[J].中国骨与关节损伤杂志,2013,28(9):834-836.
[24] 胡益文,易松敏,吴中和,等.桡骨远端骨折畸形愈合的原因及对腕关节功能的影响[J].中国骨与关节损伤杂志,2014, 29(3): 300-301.
[25] 王翔宇,郭亮兵.掌侧锁定加压钢板内固定治疗桡骨远端骨质疏松性骨折临床疗效分析[J].中国实用医刊, 2012,39(21):36-38.
[26] 薛理新,季宝兵,戴桂龙.导致桡骨远端骨折术后桡骨短缩的发生率及其危险因素分析[J].中国骨与关节损伤杂志, 2014, 29(1): 52-54.
[27] 唐开武.尺骨茎突骨折及分型对桡骨远端骨折术后临床疗效的影响[J].中国现代医生,2013,51(9):6-7.
[28] 姜保国,张殿英,傅忠国,等.桡骨远端粉碎性骨折及关节内骨折的手术治疗[J].中华骨科杂志,2002,22(2):80-83.
[29] 陆邦超,孟萍,黄姝,等.重庆市城区正常人群骨密度状况分析[J].第三军医大学学报,2003,25(10):910-912.
[30] 季志民,马亚红.北京城区居民骨密度随年龄变化的特点-3285例骨密度测定结果分析[J].中国骨质疏松杂志,2011,17(8): 687-690.
[31] 张施展,蒋林,简小飞,等.鲑鱼降钙素联合手术治疗骨质疏松性桡骨远端背侧不稳定性骨折对患者术后疗效及骨密度改变的分析[J].中国骨质疏松杂志,2013,19(8):812-858.
[32] 陈旸,程涛,徐峥宇,等.骨质疏松症对老年桡骨远端不稳定型骨折术后功能和影像学结果的影响[J].中国骨质疏松杂志,2013, 19(4): 371-374.