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两种治疗方案对老年人桡骨远端骨折的疗效比较

  • 穆合甫尔·买合斯托夫

    机 构：

    新疆医科大学第一附属医院（乌鲁木齐 830054 ）

    ×
  • ，胥伯勇

    机 构：

    新疆医科大学第一附属医院（乌鲁木齐 830054 ）

    ×
  • ，张晓岗

    机 构：

    新疆医科大学第一附属医院（乌鲁木齐 830054 ）

    ×
  • ，买买提明·赛依提

    机 构：

    新疆医科大学第一附属医院（乌鲁木齐 830054 ）

    ×

新疆医科大学第一附属医院（乌鲁木齐 830054 ）；

Evaluation of the efficacy of two regimens in the treatment of distal radius fractures in the elderly

  • MUHEFUER Maihesituofu

    Affiliation：

    Orthopaedic Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi ( 830054 ),China

    ×
  • ，XU Bo-yong

    Affiliation：

    Orthopaedic Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi ( 830054 ),China

    ×
  • ，ZHANG Xiao-gang

    Affiliation：

    Orthopaedic Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi ( 830054 ),China

    ×
  • ，MAIMAITIMING Saiyiti

    Affiliation：

    Orthopaedic Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi ( 830054 ),China

    ×

Orthopaedic Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi ( 830054 ),China；

通讯作者:

买买提明·赛依提，E-mail：2402358306@qq.com

中图分类号:R683.41

文献标识码:A

DOI:10.3969/j.issn.1007-6948.2024.03.013

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参考文献 11
姜保国,张殿英,付中国,等.桡骨远端骨折的治疗建议[J].中华创伤骨科杂志,2010,12(11):1053-1056.
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参考文献 12
邓建海,宋晓玺,张莉,等.手法复位石膏外固定与切开复位钢板内固定治疗骨质疏松性桡骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2018,33(11):1218-1219.
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参考文献 14
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目录contents

    摘要

    目的：探讨采用保守治疗和切开复位内固定两种方案对65岁以上老年人桡骨远端骨折(DRF)的疗效。方法：选择我院于2020年6月—2022年2月收治的DRF患者81例，依据随机数法分为手法组（46例）与切开组（35例）。手法组采用骨折手法复位高分子聚酯绷带固定治疗；切开组采用切开复位内固定手术治疗。使用X线片对比患者治疗前后的尺偏角、掌偏角和桡骨高度，以评估治疗情况。统计患者末次随访的改良Mayo腕关节评分（MMWS）、DASH-Chinese上肢功能评分以及并发症，对患者预后评价。结果：两组治疗后尺偏角、掌偏角和桡骨高度较治疗前增加（P＜0.05）；切开组治疗后尺偏角、掌偏角和桡骨高度高于手法组（P＜0.05）。两组治疗后MMWS较治疗前增加，而DASH-Chinese上肢功能评分较治疗前降低（P＜0.05）；切开组治疗后MMWS高于手法组，而DASH-Chinese上肢功能评分低于手法组（P＜0.05）。切开组并发症发生率低于手法组（P＜0.05）。结论：切开复位内固定术治疗老年人DRF有明显的临床优势，可以促进患者腕关节和上肢功能恢复。

    Abstract

    Objective To explore the effects of conservative treatment and open reduction with internal fixation on the quality of life and therapeutic effect of the elderly over 65 years old. Methods The 81 patients with distal radius fractures in our hospital from June 2020 to February 2022 were selected and randomly divided into a manual group (46 cases) and an incision group (35 cases). The manipulation group was treated with fracture reduction and high polymer polyester bandage fixation; the incision group was treated with open reduction and internal fixation surgery. X-ray films were used to compare the ulnar deviation, palmar deviation and radius height before and after treatment. To assess treatment. The modified Mayo wrist score (MMWS), dash Chinese upper limb function score and the incidence of complications in the last follow-up were counted to evaluate the prognosis of the patients. Results After treatment, the ulnar deviation angle, palmar deviation angle, and radius height of the two groups increased compared to before treatment (P＜0.05); after treatment, the ulnar deviation angle, palmar deviation angle, and radius height in incision group were higher than those in manipulation group (P＜0.05). After treatment, the MMWS of the two groups increased compared to before treatment, while the DASH Chinese upper limb function score decreased compared to before treatment (P＜0.05); after treatment, the MMWS of incision group was higher than that of manipulation group, while the DASH Chinese upper limb function score was lower than that of manipulation group (P＜0.05). The incidence of complications in group B was lower than that in manipulation group (P＜0.05). Conclusion The results of this study show that open reduction and internal fixation has obvious clinical advantages in the treatment of distal radius fractures in the elderly, and can promote the recovery of wrist and upper limb function.

  • 桡骨远端骨折（distal radius fractures，DRF）是最常见的骨折之一，约 25%的骨折属于关节内骨折[1]。 DRF 多发生于桡骨远端，此部位是密质骨和松质骨的交界处，此处骨质强度较薄弱，因此易发生骨折[2]。据统计，大约 60%的 DRF 伴有移位，需要复位治疗[3]。流行病学研究指出，DRF 发病率最高的是儿童和老年人[4]。目前常用的 DRF 分型是 AO 分型，根据 AO 分型可以分为关节外骨折（A 型）、简单关节内骨折 （B 型）、复杂关节内骨折（C 型）[5]。目前 DRF 的手术治疗方案包括切开复位内固定、切开复位外固定、切开复位克氏针固定，以及保守治疗等[6-7]。每种方法都有其独特的优点和并发症，尚无推荐具体的治疗方案[8]。治疗方案的选择取决于多种因素，如患者的年龄、生活方式、患者依从性、骨折类型、骨折严重程度及骨折移位程度等[9-10]。一个重要的先决条件是区分稳定骨折和不稳定骨折，对于简单骨折、稳定性关节外骨折及部分关节内骨折，通常可以采取保守治疗；但对于不稳定性骨折、多数关节内骨折，多采用手术治疗[11-13]。闭合复位高分子聚酯绷带固定具有治疗简单、费用低等优点。使用掌侧钛板切开复位内固定 （open reduction and internal fixation，ORIF）是一种更常见的手术治疗方案[14-15]。本研究对比分析两种治疗方案对老年人 DRF 的疗效。

  • 1 资料和方法

  • 1.1 一般资料

  • 本研究选择新疆医科大学第一附属医院2020年6月—2022年2月收治的DRF患者。纳入标准：1）年龄超过65岁；2）DRF，伴有或不伴有尺茎突骨折；3）上肢或手部无其他骨折。排除标准：1）开放性骨折；2）舟骨和/或其他腕骨相关骨折；3）不稳定性骨折；4）复杂关节内骨折；5）病理性骨折；6）既往存在骨科疾患患者；7）既往存在先天性畸形、先天性神经血管疾病患者；8）骨折合并颅脑损伤等其他合并症患者；9）干骺端异常、骨组织发育不良的患者。按照上述纳排标准，最终有81例患者选入该研究。根据随机数法分为手法组（46例）与切开组（35例）。两组患者在年龄、性别、骨折类型等方面比较差异无统计学意义（P >0.05），具有可比性，见表1。本研究获得医院伦理委员会审批（审批号：IACUC20190618-02），患者均签署知情同意书。

  • 1.2 治疗方法

  • 手法组：复位时局部注射利多卡因，麻醉生效后进行手法复位治疗。首先持续缓慢牵引，直至畸形被矫正，同时用手法复位方法矫正患者掌侧或背侧成角移位及桡侧移位等，复位完成后拍摄X线片确定骨折复位良好，在另一名助手的牵引下，使用高分子聚酯绷带将患者腕关节固定为掌屈位、尺偏位固定。随后患者前臂使用吊带悬吊。第1、2、4周复查评估复位情况，若患者复位良好，则可拆除高分子聚酯绷带，并指导患者进行腕关节功能锻炼。

  • 表1 两组患者一般资料比较

  • 切开组：麻醉生效后，患者取仰卧位，常规消毒皮肤，铺无菌单。取桡骨远端掌侧纵行切口，长约7 cm，依次切开皮肤、皮下组织、深筋膜；钝性分离掌长肌腱，纵行切开屈肌支持带，将桡动脉牵拉至桡侧，将正中神经牵拉至尺侧，显露旋前方肌，钝性分离旋前方肌，显露桡骨远端骨折端，见断端血肿形成，可见桡骨远端掌侧关节面骨折，骨折线呈冠状位，骨折块向掌侧移位。清除血肿、嵌压的软组织，复位骨折块，两枚克氏针交叉临时固定骨折块，透视下见复位良好，关节面光滑，掌倾角和尺偏角恢复良好。于骨折端掌侧放置解剖锁定钢板一块，钻孔测深后，拧入皮质骨螺钉1枚，再次透视见复位满意，钻孔测深后依次拧入锁定钉6枚，再次透视见复位满意，冲洗伤口缝合包扎。第1、3、6周复查评估复位情况，术后2周指导患者腕关节功能锻炼。

  • 1.3 观察指标

  • 在第1、2、4周，每月定期复查1次，至12个月，拍摄腕关节X线片，测量掌倾角度数、尺偏角度数，以及桡骨高度，评定患者末次随访时的改良Mayo腕关节评分（modified Mayo wrist score，MMWS）、DASH-Chinese上肢功能评分。

  • 1.3.1 影像学评价

  • 患者随访复查时，取腕关节的标准前后位和侧位，拍摄X线片，测量掌倾角度数、尺偏角度数，以及桡骨高度。

  • 1.3.2 MMWS

  • 于治疗前和治疗后（治疗后12个月）评价，MMWS 100[16-17]分，分别为“评估者对疼痛的评估（25分）、主动屈/伸度占对侧的百分比（25分）、握力占对侧的百分比（25分）及恢复正常工作或活动的能力（25分）”。根据患者的主观描述，评估者将疼痛分为无（25分）、轻度（20分）、中度（10分）、重度（0分）。

  • 1.3.3 DASH-Chinese上肢功能评分

  • 于治疗前和治疗后（治疗后12个月）评价，DASH-Chinese上肢功能评分是一份用于评估患者症状和身体功能的问卷[18]，包含30个项目：21个项目评估特定任务的难度，5个项目评估症状（2疼痛、1麻木、1僵硬和1虚弱），4个项目评估以下各项：社会功能、工作功能、睡眠和信心。评分0~100分，分数越高提示上肢功能越差。

  • 1.4 统计学方法

  • 数据使用SPSS 22.0统计软件进行处理，计量资料使用均数±标准差（x-±s）表示，并使用两独立样本t检验，计数资料使用χ2检验，P＜0.05表示差异有统计学意义。

  • 2 结果

  • 2.1 两组患者影像学检查结果比较

  • 治疗前，两组尺偏角、掌偏角和桡骨高度比较差异无统计学意义（P>0.05）；治疗后，两组尺偏角、掌偏角和桡骨高度较治疗前增加（P＜0.05）；切开组治疗后尺偏角、掌偏角和桡骨高度高于手法组（P＜0.05）。见表2，图1、图2。

  • 表2 两组患者影像学检查结果比较

  • 注：a与治疗前同组比较，P＜0.05；b与手法组比较，P＜0.05

  • 图1 保守治疗患者X线片

  • 图2 手术治疗患者X线片

  • 2.3 两组MMWS和DASH-Chinese上肢功能评分比较

  • 治疗前，两组MMWS和DASH-Chinese上肢功能评分比较差异无统计学意义（P>0.05）；治疗后，两组MMWS较治疗前增加，而DASH-Chinese上肢功能评分较治疗前降低（P＜0.05）；切开组治疗后MMWS高于手法组，而DASH-Chinese上肢功能评分低于手法组（P＜0.05）。见表3。

  • 表3 两组MMWS和DASH-Chinese上肢功能评分比较

  • 注：a与治疗前同组比较，P＜0.05；b与手法组比较，P＜0.05

  • 2.3 两组患者并发症比较

  • 切开组患者并发症发生率低于手法组（P＜0.05）。见表4。

  • 3 讨论

  • DRF在老年人群中是非常常见的骨折，目前并没有统一的治疗方案[19]，尤其是对于老年人的骨折，没有证据表明保守治疗或者手术治疗存在优越性。老年患者因为骨质疏松，所以更容易发生DRF。通过饮食或药物治疗可以预防骨质疏松，如维生素D、钙、双膦酸盐药物和重组人甲状旁腺激素（PTH）等[20-21]，从而达到预防骨折的目的。Fitzpatrick等[22]研究发现，同样是通过ORIF治疗DRF，骨质疏松症患者并发症发生率较高，他们认为其原因可能是骨质疏松症患者桡骨远端骨密度低有关。

  • 表4 两组患者并发症比较

  • 注：a与手法组比较，P＜0.05

  • 本研究的目的是通过对比保守治疗和手术治疗，验证外科手术治疗老年患者DRF是否有真正的优势。随访包括定期拍摄腕关节X线片，测量掌倾角度数、尺偏角度数，以及桡骨高度，评定患者末次随访时的MMWS、DASH-Chinese上肢功能评分。本研究的数据显示，两组患者经过不同的治疗后，尺偏角、掌偏角和桡骨高度有明显差异，MMWS和DASH-Chinese上肢功能评分也有明显差异（P＜0.05），这一结果与周小平等[23]进行的研究一致。手术组并发症发生率明显低于保守组，然而仅移位和创伤后关节炎存在统计学差异，其余并发症无统计学意义。

  • Toon等[24]随访了60例闭合性桡骨远端关节内骨折患者，手术组和保守组在腕关节评分、握力等方面无显著性差异，但保守组掌倾角度数、尺偏角度数及桡骨高度均明显优于手术组。Toon等指出需要更长时间的随访来确定有无后续的并发症，故为了避免手术创伤，麻醉创伤带来的并发症及后遗症及昂贵的手术费用。Martinez-Mendez等[25]分析了老年患者的临床和影像学结果，发现手术组的临床效果较好。但是目前对于老年人的DRF，治疗方案与临床效果的长期性关系还不得而知，需要更多的循证研究。本研究存在一定的局限性，首先，这是一项在单一中心进行的回顾性研究，样本量不多，但是由于患者自身原因，如经费问题，自身存在疾病（帕金森氏症、阿尔茨海默氏症、心血管疾病）等，患者最终拒绝手术治疗。

  • 综上所述，切开复位内固定术治疗老年人DRF有明显的临床优势，可以促进患者腕关节和上肢功能恢复。但因本研究纳入样本量有限，结果可能存在一定偏倚，后期有待扩大样本量，进行更深入研究，以提高研究结果的可靠度。还需要进行更大规模的随机试验，以评价不同的治疗方案对老年人生活质量的影响。

  • 参考文献

    • [1] Vosbikian MM,Ketonis C,Huang R,et al.Optimal positioning for volar plate fixation of a distal radius fracture:determining the distal dorsal cortical distance[J].Orthop Clin North Am,2016,47(1):235-244.

    • [2] Wu YS,Yang J,Xie LZ,et al.Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly[J].ANZ J Surg,2019,89(10):E428-E432.

    • [3] Mulders MAM,van Eerten PV,Goslings JC,et al.Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes,however at the expense of 40% subsequent surgeries[J].Orthop Traumatol Surg Res,2017,103(6):905-909.

    • [4] Jerrhag D,Englund M,Karlsson MK,et al.Epidemiology and time trends of distal forearm fractures in adults-a study of 11.2 million person-years in Sweden[J].BMC Musculoskelet Disord,2017,18(1):240.

    • [5] 邓乐章,许勇.桡骨远端C1～3型骨折的治疗新进展[J].医学综述,2020,26(21):4288-4291.

    • [6] Rhee PC,Shin AY.Management of complex distal radius fractures:review of treatment principles and select surgical techniques[J].J Hand Surg Asian Pac Vol,2016,21(2):140-154.

    • [7] Lee JI,Park KC,Joo IH,et al.The effect of osteoporosis on the outcomes after volar locking plate fixation in female patients older than 50 years with unstable distal radius fractures[J].J Hand Surg Am,2018,43(8):731-737.

    • [8] Hammert WC,Kramer RC,Graham B,et al.AAOS appropriate use criteria:treatment of distal radius fractures[J].J Am Acad Orthop Surg,2013,21(8):506-509.

    • [9] Bartl C,Stengel D,Bruckner T,et al.The treatment of displaced intra-articular distal radius fractures in elderly patients[J].Dtsch Arztebl Int,2014,111(46):779-787.

    • [10] Wong TC,Chiu Y,Tsang WL,et al.Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population:a prospective randomised controlled trial[J].J Hand Surg Eur Vol,2010,35(3):202-208.

    • [11] 姜保国,张殿英,付中国,等.桡骨远端骨折的治疗建议[J].中华创伤骨科杂志,2010,12(11):1053-1056.

    • [12] 邓建海,宋晓玺,张莉,等.手法复位石膏外固定与切开复位钢板内固定治疗骨质疏松性桡骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2018,33(11):1218-1219.

    • [13] 杨博宇,杜谦,蔡加兴,等.手法复位石膏固定与切开复位锁定钢板内固定治疗青壮年不稳定桡骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(9):987-989.

    • [14] Levin LS,Rozell JC,Pulos N.Distal radius fractures in the elderly[J].J Am Acad Orthop Surg,2017,25(3):179-187.

    • [15] Hammer OL,Clementsen S,Hast J,et al.Volar locking plates versus augmented external fixation of intra-articular distal radial fractures:functional results from a randomized controlled trial[J].J Bone Joint Surg Am,2019,101(4):311-321.

    • [16] Slutsky DJ.Outcomes assessment in wrist surgery[J].J Wrist Surg,2013,2(1):1-4.

    • [17] Haas F,Hubmer M,Rappl T,et al.Long-term subjective and functional evaluation after thumb replantation with special attention to the Quick DASH questionnaire and a specially designed trauma score called modified Mayo score[J].J Trauma,2011,71(2):460-466.

    • [18] Gupta S,Halai M,Al-Maiyah M,et al.Which measure should be used to assess the patient’s functional outcome after distal radius fracture?[J].Acta Orthop Belg,2014,80(1):116-118.

    • [19] Rhee PC,Medoff RJ,Shin AY.Complex distal radius fractures:an anatomic algorithm for surgical management[J].J Am Acad Orthop Surg,2017,25(2):77-88.

    • [20] Testa G,Pavone V,Mangano S,et al.Normal nutritional components and effects on bone metabolism in prevention of osteoporosis[J].J Biol Regul Homeost Agents,2015,29(3):729-736.

    • [21] Pavone V,Testa G,Giardina SMC,et al.Pharmacological therapy of osteoporosis:a systematic current review of literature[J].Front Pharmacol,2017,8:803.

    • [22] Fitzpatrick SK,Casemyr NE,Zurakowski D,et al.The effect of osteoporosis on outcomes of operatively treated distal radius fractures[J].J Hand Surg Am,2012,37(10):2027-2034.

    • [23] 周小平,庄家林,刘宗超.腕关节镜辅助切开复位内固定治疗桡骨远端骨折效果[J].中华关节外科杂志(电子版),2021,15(2):137-142.

    • [24] Toon DH,Premchand RAX,Sim J,et al.Outcomes and financial implications of intra-articular distal radius fractures:a comparative study of open reduction internal fixation(ORIF)with volar locking plates versus nonoperative management[J].J Orthop Traumatol,2017,18(3):229-234.

    • [25] Martinez-Mendez D,Lizaur-Utrilla A,de-Juan-Herrero J.Intra-articular distal radius fractures in elderly patients:a randomized prospective study of casting versus volar plating[J].J Hand Surg Eur Vol,2018,43(2):142-147.

图1 保守治疗患者X线片

图2 手术治疗患者X线片

表1 两组患者一般资料比较

表2 两组患者影像学检查结果比较

表3 两组MMWS和DASH-Chinese上肢功能评分比较

表4 两组患者并发症比较

图表 1/1

  • 基本信息

    中图分类号: R683.41
    文献标识码: A
    DOI: 10.3969/j.issn.1007-6948.2024.03.013

    稿件历史

    收稿日期: 2023-11-03

  • 参考文献

    • [1] Vosbikian MM,Ketonis C,Huang R,et al.Optimal positioning for volar plate fixation of a distal radius fracture:determining the distal dorsal cortical distance[J].Orthop Clin North Am,2016,47(1):235-244.

    • [2] Wu YS,Yang J,Xie LZ,et al.Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly[J].ANZ J Surg,2019,89(10):E428-E432.

    • [3] Mulders MAM,van Eerten PV,Goslings JC,et al.Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes,however at the expense of 40% subsequent surgeries[J].Orthop Traumatol Surg Res,2017,103(6):905-909.

    • [4] Jerrhag D,Englund M,Karlsson MK,et al.Epidemiology and time trends of distal forearm fractures in adults-a study of 11.2 million person-years in Sweden[J].BMC Musculoskelet Disord,2017,18(1):240.

    • [5] 邓乐章,许勇.桡骨远端C1～3型骨折的治疗新进展[J].医学综述,2020,26(21):4288-4291.

    • [6] Rhee PC,Shin AY.Management of complex distal radius fractures:review of treatment principles and select surgical techniques[J].J Hand Surg Asian Pac Vol,2016,21(2):140-154.

    • [7] Lee JI,Park KC,Joo IH,et al.The effect of osteoporosis on the outcomes after volar locking plate fixation in female patients older than 50 years with unstable distal radius fractures[J].J Hand Surg Am,2018,43(8):731-737.

    • [8] Hammert WC,Kramer RC,Graham B,et al.AAOS appropriate use criteria:treatment of distal radius fractures[J].J Am Acad Orthop Surg,2013,21(8):506-509.

    • [9] Bartl C,Stengel D,Bruckner T,et al.The treatment of displaced intra-articular distal radius fractures in elderly patients[J].Dtsch Arztebl Int,2014,111(46):779-787.

    • [10] Wong TC,Chiu Y,Tsang WL,et al.Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population:a prospective randomised controlled trial[J].J Hand Surg Eur Vol,2010,35(3):202-208.

    • [11] 姜保国,张殿英,付中国,等.桡骨远端骨折的治疗建议[J].中华创伤骨科杂志,2010,12(11):1053-1056.

    • [12] 邓建海,宋晓玺,张莉,等.手法复位石膏外固定与切开复位钢板内固定治疗骨质疏松性桡骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2018,33(11):1218-1219.

    • [13] 杨博宇,杜谦,蔡加兴,等.手法复位石膏固定与切开复位锁定钢板内固定治疗青壮年不稳定桡骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(9):987-989.

    • [14] Levin LS,Rozell JC,Pulos N.Distal radius fractures in the elderly[J].J Am Acad Orthop Surg,2017,25(3):179-187.

    • [15] Hammer OL,Clementsen S,Hast J,et al.Volar locking plates versus augmented external fixation of intra-articular distal radial fractures:functional results from a randomized controlled trial[J].J Bone Joint Surg Am,2019,101(4):311-321.

    • [16] Slutsky DJ.Outcomes assessment in wrist surgery[J].J Wrist Surg,2013,2(1):1-4.

    • [17] Haas F,Hubmer M,Rappl T,et al.Long-term subjective and functional evaluation after thumb replantation with special attention to the Quick DASH questionnaire and a specially designed trauma score called modified Mayo score[J].J Trauma,2011,71(2):460-466.

    • [18] Gupta S,Halai M,Al-Maiyah M,et al.Which measure should be used to assess the patient’s functional outcome after distal radius fracture?[J].Acta Orthop Belg,2014,80(1):116-118.

    • [19] Rhee PC,Medoff RJ,Shin AY.Complex distal radius fractures:an anatomic algorithm for surgical management[J].J Am Acad Orthop Surg,2017,25(2):77-88.

    • [20] Testa G,Pavone V,Mangano S,et al.Normal nutritional components and effects on bone metabolism in prevention of osteoporosis[J].J Biol Regul Homeost Agents,2015,29(3):729-736.

    • [21] Pavone V,Testa G,Giardina SMC,et al.Pharmacological therapy of osteoporosis:a systematic current review of literature[J].Front Pharmacol,2017,8:803.

    • [22] Fitzpatrick SK,Casemyr NE,Zurakowski D,et al.The effect of osteoporosis on outcomes of operatively treated distal radius fractures[J].J Hand Surg Am,2012,37(10):2027-2034.

    • [23] 周小平,庄家林,刘宗超.腕关节镜辅助切开复位内固定治疗桡骨远端骨折效果[J].中华关节外科杂志(电子版),2021,15(2):137-142.

    • [24] Toon DH,Premchand RAX,Sim J,et al.Outcomes and financial implications of intra-articular distal radius fractures:a comparative study of open reduction internal fixation(ORIF)with volar locking plates versus nonoperative management[J].J Orthop Traumatol,2017,18(3):229-234.

    • [25] Martinez-Mendez D,Lizaur-Utrilla A,de-Juan-Herrero J.Intra-articular distal radius fractures in elderly patients:a randomized prospective study of casting versus volar plating[J].J Hand Surg Eur Vol,2018,43(2):142-147.


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