桡骨远端骨折的治疗策略及研究进展

Treatment Strategies and Research Progress of Distal Radius Fractures

摘要: 本综述围绕桡骨远端骨折(DRF)的治疗策略与研究进展，对19篇相关或方法学可迁移的文献进行归纳。临床证据显示，相较保守治疗，手术尤其以掌侧锁定钢板为代表的稳定内固定，在功能恢复、影像学复位维持与并发症控制方面更具优势；但对稳定或可满意复位的病例，规范手法复位与外固定仍可获得良好短期结局，夹板–石膏交替固定有助于加速愈合。针对畸形愈合，结合截骨与髂嵴植骨的重建可改善疼痛与力线。来自踝、距骨等关节周围骨折的研究提示：在保证解剖复位的前提下，微创理念与恰当入路选择可减少软组织损伤并缩短康复过程，为DRF手术路径与器械选择提供借鉴。方法学层面，有限元与参数化建模、MRI定量计量及数字化设计3D打印为个体化内外固定与术前力学评估提供工具；同时，ROC曲面、径向MR等先进统计与因果推断方法，联合本体感觉与神经肌肉功能客观测评，可用于优化预后分层与康复评估。未来应开展高质量随机研究，并推动生物力学建模、影像计量与因果推断的跨学科整合。

Abstract: Drawing on 19 clinical and methodology-transferable studies, this narrative review synthesizes current strategies and advances in the management of distal radius fractures (DRF). Comparative clinical evidence favors operative fixation—particularly volar locking plates—over nonoperative care for superior maintenance of reduction, faster union, better wrist function, and fewer complications; nevertheless, well-performed closed reduction with external immobilization remains effective in stable or satisfactorily reducible fractures, and alternating splint-cast protocols may expedite healing. For symptomatic malunions, corrective osteotomy with trapezoidal iliac crest grafting can restore alignment and alleviate pain. Evidence from periarticular fractures of the ankle and talus underscores that, once anatomic reduction is secured, minimally invasive concepts and thoughtful surgical approach selection mitigate soft-tissue morbidity and may accelerate recovery, offering reference for DRF surgical approaches and instrument selection. Methodologically, finite element and parameterized modeling, quantitative MRI metrics, and digital3D-printed designs enable patient-specific planning and preoperative biomechanical evaluation. In parallel, advanced analytics—including ROC surfaces for ordinal competing risks and radial Mendelian randomization—combined with objective assessments of proprioception and neuromuscular function, offer robust frameworks for prognostic modeling and rehabilitation monitoring. High-quality randomized studies should be conducted in the future, and interdisciplinary integration of biomechanical modeling, imaging measurement and causal inference should be promoted.