桡骨远端中间柱骨折的分型和价值探讨

Classification of intermediate column fractures of distal radius and its value

摘要:

目的  对桡骨远端中间柱骨折（ICF）类型进行归纳总结，提出新分型，并探讨分型的一致性和临床价值。方法  将64例ICF归纳分为：掌侧型、背侧型、劈裂型、塌陷型和塌陷伴劈裂型。采用Kappa方法分析观察者间和观察者内的分型一致性。根据分型指导45例有移位ICF手术入路和复位固定方法的选择，无明显移位骨折13例和有移位但患者拒绝手术6例均采取保守治疗。腕关节功能按Gartland-Werley评分标准评价。结果  背侧型、掌侧型、劈裂型、塌陷型和塌陷伴劈裂型分别为：13、3、10、25和13例。观察者间和观察者内Kappa系数分别为0.875～0.900和0.900～0.925，高度一致性。均获13～36个月（平均18.4个月）随访。末次随访，手术组1例塌陷伴劈裂型骨折因手术复位不满意，保守组5例塌陷型骨折因拒绝手术采取保守治疗，结果均发生创伤性腕关节炎，功能恢复为可，其余均为优或良。手术组与保守组发生创伤性腕关节炎比较，差异有统计学意义（χ2=
4.197，P =0.041）；塌陷和塌陷伴劈裂型发生创伤性腕关节炎比较，差异有统计学意义（χ2=9.128，P =0.003）。结论  ICF分型较好地反映了骨折特点，对选择治疗方法和评估疗效具有较好的参考价值。

Abstract:

Objective To summarize types of intermediate column fractures of the distal radius (ICF), to put up a new classification and investigate its agreement and clinical value. Methods Sixty-four patients with ICF were summarized and divided into the volar, dorsal, split, collapse and collapse with split types. Inter- and intra-observer agreements were analyzed with Kappa statistics. Surgical approach and reduction-fixation method was taken under the guidance of the classification in 45 patients with displaced ICF, while conservative treatment was taken in 13 patients without obvious displaced fractures and 6 patients with displaced fractures who declined surgery. The functional recovery of wrist was evaluated according to Gartland and Werley score. Results The dorsal, volar, split, collapse, and collapse with split types were found in 13, 3, 10, 25 and 13 patients, respectively. The inter- and intra-observer Kappa coefficients were 0.875-0.900, and 0.900-0.925, respectively, indicating almost perfect agreement. All patients were followed-up for 13-36 months (average 18.4 months). At the last follow-up, 1 patient who belonged to displaced collapse with split type had poor reduction of fracture and 5 patients who belonged to displaced collapse type but opted for conservative treatment instead of surgery developed into traumatic arthritis of wrist and had fair results, the rest had excellent or good results. The incidence of traumatic arthritis showed significant difference between the surgery group and the conservative group (χ2 = 4.197, P = 0.041); the difference in the incidence of traumatic arthritis was significant between the collapse group and collapse with split group(χ2 = 9.128, P = 0.003). Conclusions The classification well reflects the characteristics of ICF and may provide an important reference for choosing treatment and evaluating prognosis.