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英国牛津大学Matthew L Costa团队比较了成人桡骨远端骨折采用克氏针固定和石膏固定对腕关节功能的影响。该研究于2022年1月19日发表于《英国医学杂志》上。

为了评估采用石膏或外科克氏针固定治疗的桡骨远端背侧移位骨折成年患者的腕关节功能、生活质量和并发症，研究组在英国国家卫生服务局（NHS）的36家医院进行了一项多中心、随机、临床优势试验。

共招募了500名16岁及以上桡骨远端向背侧移位骨折的成年人，在骨折手法复位后随机分组，其中255例为石膏固定，245例为克氏针固定。对两组进行比较。石膏的使用和克氏针插入的细节根据正常临床实践，由治疗外科医生决定。

主要结局是患者在12个月时的腕关节评估（PRWE）评分（5个关于疼痛的问题，10个关于功能和残疾的问题；总分为100分，分数越高病情越严重）。次要结局为三个月和六个月时的PRWE评分、生活质量和并发症，包括前六周因骨折复位丢失而需要手术。

参与者的平均年龄为60岁，417名（83%）为女性；395人（79%）完成了随访。12个月时，石膏固定组（200名）的平均PRWE评分为21.2分，克氏针固定组（195名）为20.7分，组间无统计学差异。

在较早的时间点未发现显著差异。石膏固定组中有33名（13%）参与者在前六周因骨折复位丢失而需要手术固定，克氏针固定组中仅有1位患者需要翻修手术，显著优于石膏固定组。

研究结果表明，在需要手法复位的桡骨远端背侧移位骨折患者中，与石膏固定相比，采用克氏针固定在12个月时并没有显著改善患者的腕关节功能。

附：英文原文

Title: Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial

Author: Matthew L Costa, Juul Achten, Alexander Ooms, May Ee Png, Jonathan A Cook, Sarah E Lamb, Helen Hedley, Joseph Dias

Issue&Volume: 2022/01/19

Abstract:

Objective To assess wrist function, quality of life, and complications in adult patients with a dorsally displaced fracture of the distal radius, treated with either a moulded cast or surgical fixation with K-wires.

Design Multicentre randomised clinical superiority trial,

Setting 36 hospitals in the UK National Health Service (NHS).

Participants 500 adults aged 16 or over with a dorsally displaced fracture of the distal radius, randomised after manipulation of their fracture (255 to moulded cast; 245 to surgical fixation).

Interventions Manipulation and moulded cast was compared with manipulation and surgical fixation with K-wires plus cast. Details of the application of the cast and the insertion of the K-wires were at the discretion of the treating surgeon, according to their normal clinical practice.

Main outcome measures The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months (five questions about pain and 10 about function and disability; overall score out of 100 (best score=0 and worst score=100)). Secondary outcomes were PRWE score at three and six months, quality of life, and complications, including the need for surgery due to loss of fracture position in the first six weeks.

Results The mean age of participants was 60 years and 417 (83%) were women; 395 (79%) completed follow-up. No statistically significant difference in the PRWE score was seen at 12 months (cast group (n=200), mean 21.2 (SD 23.1); K-wire group (n=195), mean 20.7 (22.3); adjusted mean difference 0.34 (95% confidence interval 4.33 to 3.66), P=0.87). No difference was seen at earlier time points. In the cast group, 33 (13%) of participants needed surgical fixation for loss of fracture position in the first six weeks compared with one revision surgery in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10).

Conclusions Among patients with a dorsally displaced distal radius fracture that needed manipulation, surgical fixation with K-wires did not improve patients’ wrist function at 12 months compared with a cast.

DOI: 10.1136/bmj-2021-068041

Source: https://www.bmj.com/content/376/bmj-2021-068041

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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