掌側ロッキングプレートを施行した背側転位型橈骨遠位端骨折の治療成績―本当によい治療法なのか？

Clinical Results of Palmar Locking Plate Fixation for Dorsally Displaced Fractures of the Distal Radius

　掌側ロッキングプレートで内固定した背側転位型橈骨遠位端骨折55例55骨折を対象にX線形態計測，自動関節可動域，握力の推移について調査した．尺側傾斜，掌側傾斜，尺骨変異の整復位損失は，0°，0.7°，0.7mmであった．最終調査時までに，自動関節可動域は健側比で89～98％，握力は79％まで回復した．掌側ロッキングプレートは他覚的評価に優れていたが，手関節尺側部痛が8例に遺残し，決して自覚的評価に優れているわけではなかった．今後，さらに安心できる治療法へ確立していく必要がある．

　A consecutive series of 55 dorsally displaced fractures of the distal radius consisting of 19 extra-articular fractures and 36 intra-articular fractures was treated surgically by means of palmar locking plating systems. There were 22 men and 33 women, and their mean age at the time of the injury was 57.1 years (range：19～87 years). The mean follow-up period was 30 weeks (range：12～88 weeks). At the time of the final follow-up examination, the mean loss of correction of ulnar inclination, palmar tilt, and ulnar variance were 0°, 0.7°, and 0.7mm, respectively. According to Saito score, the results were excellent in 47 cases, good in 7 cases, and fair in 1 case. Eight patients complained of ulnar wrist pain at the time of the final evaluation. The results suggest that the advantage of the palmar locking systems may lie in being more effective in objective assessments, such as by radiographic parameters, range of motion, and grip strength, not in subjective assessments.