Fuller D A, Barrett M, Marburger R K, Hirsch R
Department of Surgery, Division of Orthopaedics, University of Medicine and Dentistry of New Jersey, Camden, NJ, USA.
J Hand Surg Br. 2006 Apr;31(2):236-9. doi: 10.1016/j.jhsb.2005.10.013. Epub 2005 Dec 15.
Elevated pressures within the carpal canal are known to occur after distal radius fractures. Controversy exists regarding prophylactic carpal tunnel release after open reduction with internal fixation of distal radius fractures. The purpose of this study was to determine the tissue pressures within the carpal canal after volar plating of distal radius fractures. This study was a prospective, observational, IRB approved research study. Ten consecutive patients undergoing volar plating of distal radius fractures were enrolled. After the distal radius fractures were reduced and fixed with volar plates, slit catheters were inserted into the carpal canals for continuous postoperative pressure monitoring for 24 hours. The maximum recorded pressure was 65 mmHg, which occurred in the only patient with fracture blisters. Peak pressures remained at 40 mmHg or less (range 16-40, mean 29) in all patients without fracture blisters. At the conclusion of data collection, all pressures were at 31 mmHg or less. No patient complained of median nerve dysfunction during the study period. Routine prophylactic carpal tunnel release is not recommended after volar plating of distal radius fractures based on these pressure recordings.
已知桡骨远端骨折后腕管内压力会升高。对于桡骨远端骨折切开复位内固定术后预防性腕管松解术存在争议。本研究的目的是确定桡骨远端骨折掌侧钢板固定术后腕管内的组织压力。本研究是一项经机构审查委员会（IRB）批准的前瞻性观察性研究。连续纳入10例行桡骨远端骨折掌侧钢板固定术的患者。在桡骨远端骨折用掌侧钢板复位固定后，将裂隙导管插入腕管进行术后24小时连续压力监测。记录到的最大压力为65 mmHg，发生在唯一一名有骨折水疱的患者身上。所有没有骨折水疱的患者峰值压力均保持在40 mmHg或更低（范围16 - 40，平均29）。在数据收集结束时，所有压力均在31 mmHg或更低。在研究期间没有患者抱怨正中神经功能障碍。基于这些压力记录，不建议在桡骨远端骨折掌侧钢板固定术后常规进行预防性腕管松解术。
