- 期刊
- OpenAccess
Stabilization in Surgical Treatment of Comminuted Distal Radius Fracture: Clinical Comparisons between Bone Graft Substitute and Locking Plate
比較注射型人工骨和鎖定式骨板對於遠端橈骨粉碎性骨折治療的穩定性差異
摘要
遠端橈骨骨折為各年齡層均常見的骨折，當粉碎程度增加，臨床治療的成效就越差。以手術穩定骨折碎片，對於粉碎性遠端橈骨骨折相當重要；不同的手術固定方式也產生不同的臨床治療成果。許多因素都會影響到遠端橈骨骨折的治療成果，近年來因為人工骨骼替代物技術的進步，可以提供粉碎型骨折更好的支撐力。我們提出相關的臨床資料，探討注射型人工骨骼替代物的力學穩定度在治療粉碎型遠端橈骨骨折的成果。以回溯型研究分析六十二位因粉碎型遠端橈骨骨折於本院接受治療的病人；平均年齡為62.4歲（30至89歲），平均追蹤時間為11.8週（8至26週）。其中30位病人接受開放式復位及鎖定式骨板固定，另外32位病人接受閉鎖式復位及注射式人工骨骼替代物固定。並比較兩種治療方式術後追蹤的橈側傾角、掌向斜角以及尺骨關節高度的差異。比較兩組病人的追蹤結果可以發現，使用注射式人工骨骼替代物治療的病人較容易發生橈骨關節面下沉的狀況；而且治療後的橈側傾角及掌向斜角都比使用鎖定式骨板固定的病人有顯著差異。而術後的關節活動度在兩組病人之間是沒有差異的。雖然注射式人工骨骼替代物在生物力學上有足夠支撐強度，但在臨床上仍缺乏足夠的病人數據證明其力學強度。在我們的臨床數據發現，注射式人工骨骼替代物無法提供與鎖定式骨板相同的生物力學強度。因此在臨床上，仍建議將注射式人工骨骼替代物與更強的固定裝置合併使用，以達到較佳的治療成果。
並列摘要
Distal radius fracture is extremely common; its clinical outcome is worse when the fracture is severely comminuted. In such cases, surgical stabilization of distal radial articular fragments is important. The different surgical techniques used for this purpose provide different stability and clinical outcomes. Improvement in the bone graft substitute provides convenience in surgical repair and may offer effective bone stability. Although injectable bone graft substitutes have demonstrated sufficient compression strength in biomechanical models, clinical experience with them has not been elucidated. In the present study, we prospectively analyzed the surgical outcomes in 62 patients (mean age at surgery, 62.4 years; range 30-89 years) with comminuted distal radius fracture. We performed open reduction with locking plate fixation in 30 patients and closed reduction with Kirschner wire fixation using injectable bone graft substitute [Minimally Invasive Injectable Graft (MIIG)] in 32 patients. We followed-up the patients for an average of 11.8 weeks (range, 8-26 weeks). We compared radiographic findings of radial inclination, palmar tilt, and ulnar variance between the two groups. Compared with the patients treated using locking plate fixation, the patients who received closed reduction with MIIG showed bone healing with statistically significant greater decrease in joint height (radial inclination and ulna variance) two months post surgery. Wrist range of motion between the two groups was equivalent postoperatively. In our clinical treatment of comminuted distal radius fracture, the bone graft does not provide sufficient stability when used by itself during bone growth as compared with the locking plate. In order to improve functional outcome, use of a bone graft substitute must be combined with other mechanical fixation methods.
延伸閱讀
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