橈骨遠位端骨折に対する掌側ロッキングプレートを用いた早期手術群と待機手術群の機能予後の比較検討
本研究の目的は，橈骨遠位端骨折の受傷から手術までの期間（早期群vs待機群）が術後成績に影響を及ぼすか否かを明らかにすることである．背側転位型橈骨遠位端関節外骨折患者106症例のうち，受傷当日もしくは翌日に掌側ロッキングプレートを用いて観血的整復固定術を施行した76例を早期群，受傷後7日目以降に手術した30例を待機群とし，術後4週，12週，48週のそれぞれの時点での可動域，握力，Disability of the Arm, Shoulder and Hand （DASH）スコア，合併症について後ろ向きに調査した．両群の患者とも，可動域，握力，DASHスコアとも有意に改善した．術後48週時は，両群...
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| Published in | Journal of UOEH Vol. 37; no. 2; pp. 111 - 119 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
学校法人 産業医科大学
2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-821X 2187-2864 |
| DOI | 10.7888/juoeh.37.111 |
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| Abstract | 本研究の目的は，橈骨遠位端骨折の受傷から手術までの期間（早期群vs待機群）が術後成績に影響を及ぼすか否かを明らかにすることである．背側転位型橈骨遠位端関節外骨折患者106症例のうち，受傷当日もしくは翌日に掌側ロッキングプレートを用いて観血的整復固定術を施行した76例を早期群，受傷後7日目以降に手術した30例を待機群とし，術後4週，12週，48週のそれぞれの時点での可動域，握力，Disability of the Arm, Shoulder and Hand （DASH）スコア，合併症について後ろ向きに調査した．両群の患者とも，可動域，握力，DASHスコアとも有意に改善した．術後48週時は，両群間に有意差を認めなかったが，早期群が待機群と比較して，術後4週は前腕・手関節可動域，握力，DASHスコア，術後12週は手関節可動域，握力，DASHスコアが有意に良好であった．手術した背側転位型橈骨遠位端関節外骨折において，受傷から手術までの待機期間が，術後早期の臨床成績に影響を及ぼす可能性が示唆された． |
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| AbstractList | 本研究の目的は，橈骨遠位端骨折の受傷から手術までの期間（早期群vs待機群）が術後成績に影響を及ぼすか否かを明らかにすることである．背側転位型橈骨遠位端関節外骨折患者106症例のうち，受傷当日もしくは翌日に掌側ロッキングプレートを用いて観血的整復固定術を施行した76例を早期群，受傷後7日目以降に手術した30例を待機群とし，術後4週，12週，48週のそれぞれの時点での可動域，握力，Disability of the Arm, Shoulder and Hand （DASH）スコア，合併症について後ろ向きに調査した．両群の患者とも，可動域，握力，DASHスコアとも有意に改善した．術後48週時は，両群間に有意差を認めなかったが，早期群が待機群と比較して，術後4週は前腕・手関節可動域，握力，DASHスコア，術後12週は手関節可動域，握力，DASHスコアが有意に良好であった．手術した背側転位型橈骨遠位端関節外骨折において，受傷から手術までの待機期間が，術後早期の臨床成績に影響を及ぼす可能性が示唆された． |
| Author | 森谷, 史朗 善家, 雄吉 大茂, 壽久 山下, 一太 酒井, 昭典 前原, 孝 |
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| References | 4. Earnshaw SA, Aladin A, Surendran S & Moran CG (2002): Closed reduction of Colles fractures: comparison of manual manipulation and finger-trap traction: A prospective, randomized study. J Bone Joint Surg Am 84: 354-358 17. Sun T, Wang X, Liu Z, Chen X & Zhang J (2011): Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients. Injury 42: 707-713 1. Souer JS, Ring D, Matschke S, Audige L, Maren-Hubert M & Jupiter J (2010) : Comparison of functional outcome after volar plate fixation with 2.4-mm titanium versus 3.5-mm stainless-steel plate for extra-articular fracture of distal radius. J Hand Surg Am 35: 398-405 14. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G & Swiontkowski MF (1996): X-ray film measurements for healed distal radius fractures. J Hand Surg Am 21: 31-39 16. Mathews A & Ridgeway V (1981): Personality and surgical recovery: a review. Br J Clin Psychol 20: 243-260 11. Orbay JL, Touhami A & Orbay C (2005): Fixed angle fixation of distal radius fractures through a minimally invasive approach. Tech Hand Up Extrem Surg 9: 142-148 12. Hudak PL, Amadio PC & Bombardier C (1996): Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected] The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29: 602-608 2. Lafontaine M, Delince P, Hardy D & Simons M (1989): Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg 55: 203-216 5. Willis AA, Kutsumi K, Zobitz ME & Cooney WP 3rd (2006): Internal fixation of dorsally displaced fractures of the distal part of the radius. a biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 88: 2411-2417 8. Musgrave DS & Idler RS (2005): Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am 30: 743-749 9. Jupiter JB & Fernandez DL (1997): Comparative classification for fractures of the distal end of the radius. J Hand Surg Am 22: 563-571 7. Orbay JL & Fernandez DL (2004): Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 29: 96-102 10. Orbay J, Badia A, Khoury RK, Gonzalez E & Indriago I (2004): Volar fixed-angle fixation of distal radius fractures: the DVR plate. Tech Hand Up Extrem Surg 8: 142-148 15. Abdelhady AM (2013): Timing of shoulder arthroplasty in comminuted proximal humerus fracture, how much does it matter? Eur J Orthop Surg Traumatol 23: 515-519 6. Rozental TD & Blazar PE (2006): Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 31: 359-365 13. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M & Rogers S (1985): Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 66: 69-74 3. Mackenney PJ, McQueen MM & Elton R (2006): Prediction of instability in distal radial fractures. J Bone Joint Surg Am 88: 1944-1951 |
| References_xml | – reference: 6. Rozental TD & Blazar PE (2006): Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 31: 359-365 – reference: 17. Sun T, Wang X, Liu Z, Chen X & Zhang J (2011): Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients. Injury 42: 707-713 – reference: 4. Earnshaw SA, Aladin A, Surendran S & Moran CG (2002): Closed reduction of Colles fractures: comparison of manual manipulation and finger-trap traction: A prospective, randomized study. J Bone Joint Surg Am 84: 354-358 – reference: 15. Abdelhady AM (2013): Timing of shoulder arthroplasty in comminuted proximal humerus fracture, how much does it matter? Eur J Orthop Surg Traumatol 23: 515-519 – reference: 5. Willis AA, Kutsumi K, Zobitz ME & Cooney WP 3rd (2006): Internal fixation of dorsally displaced fractures of the distal part of the radius. a biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 88: 2411-2417 – reference: 11. Orbay JL, Touhami A & Orbay C (2005): Fixed angle fixation of distal radius fractures through a minimally invasive approach. Tech Hand Up Extrem Surg 9: 142-148 – reference: 12. Hudak PL, Amadio PC & Bombardier C (1996): Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected] The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29: 602-608 – reference: 3. Mackenney PJ, McQueen MM & Elton R (2006): Prediction of instability in distal radial fractures. J Bone Joint Surg Am 88: 1944-1951 – reference: 8. Musgrave DS & Idler RS (2005): Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am 30: 743-749 – reference: 13. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M & Rogers S (1985): Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 66: 69-74 – reference: 1. Souer JS, Ring D, Matschke S, Audige L, Maren-Hubert M & Jupiter J (2010) : Comparison of functional outcome after volar plate fixation with 2.4-mm titanium versus 3.5-mm stainless-steel plate for extra-articular fracture of distal radius. J Hand Surg Am 35: 398-405 – reference: 7. Orbay JL & Fernandez DL (2004): Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 29: 96-102 – reference: 9. Jupiter JB & Fernandez DL (1997): Comparative classification for fractures of the distal end of the radius. J Hand Surg Am 22: 563-571 – reference: 10. Orbay J, Badia A, Khoury RK, Gonzalez E & Indriago I (2004): Volar fixed-angle fixation of distal radius fractures: the DVR plate. Tech Hand Up Extrem Surg 8: 142-148 – reference: 16. Mathews A & Ridgeway V (1981): Personality and surgical recovery: a review. Br J Clin Psychol 20: 243-260 – reference: 14. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G & Swiontkowski MF (1996): X-ray film measurements for healed distal radius fractures. J Hand Surg Am 21: 31-39 – reference: 2. Lafontaine M, Delince P, Hardy D & Simons M (1989): Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg 55: 203-216 |
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| SubjectTerms | 手術時期 掌側ロッキングプレート 橈骨遠位端骨折 機能的予後 関節外骨折 |
| Title | 橈骨遠位端骨折に対する掌側ロッキングプレートを用いた早期手術群と待機手術群の機能予後の比較検討 |
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