Locking Plate for AO Type C Intra-articular Distal Radius Fracture: Volar or Dorsal Approach?: 以鎖定鋼板治療AO- C型橈骨遠端關節內骨折 ---- 應使用掌側抑或背側入路?

PurposeThere is controversy over the outcomes and complications of volar and dorsal plating for the treatment of intra-articular fracture distal radius.MethodsFrom 2008 to 2010, 81 patients with intra-articular fracture distal radius of AO type C1–C3 treated with distal radius locking plates via volar or dorsal approaches were reviewed in our institute. The clinical, radiological, and functional outcomes were evaluated at 6 months after operation.ResultsThe volar approach group showed a significantly better flexion range, flexion-extension arc as well as Green and O'Brien functional score than dorsal approach group. Volar tilting of the distal radius was significantly better in the dorsal group, but that did not contribute to better palmar–flexion range or grip strength. Overall complication rate was similar in both groups.ConclusionThe volar approach group demonstrated better range of motion and functional score. The complication rates were similar between the two groups. The volar surgical approach should be adopted in most operative cases of AO type C intra-articular fracture distal radius while the dorsal approach should be reserved for intra-articular fracture with dorsal comminuted fragments.

中文摘要目的：關於以鋼板內固定手術去治療橈骨遠端關節內骨折，使用掌側抑或背側入路，效果和拼發症都存有爭論。方法：從2008年到2010年，我們回顧研究本院的81例患者，以鎖定鋼板手術治療AO---C1到C3型橈骨遠端關節內骨折，通過掌側或背側的方法入路。在術後6個月，評估其臨床，影像學和功能結果。結果：對比背側入路組，掌側入路組有更好的屈曲範圍，屈伸弧度以及格林和奧布萊恩的功能評分。背側入路組雖然有較好的橈骨遠端掌側斜角，但對屈伸弧度或握力卻沒有幫助。兩組的總體併發症發生率相似。結論：掌側入路組有更好的活動範圍和功能評分而兩組的併發症發生率相似，所以我們認為以鎖定鋼板內固定手術治療AO---C型橈骨遠端關節內骨折的大多數病例中，應採用掌側入路，而背側入路應只用於有背側粉碎性關節內骨折的情況。