Abe Yukio, Tsubone Tetsu, Tominaga Yasuhiro
Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan.
Tech Hand Up Extrem Surg. 2008 Sep;12(3):136-43. doi: 10.1097/BTH.0b013e3181670fe3.
Wrist arthroscopy for the distal radius fractures is an effective adjunct to evaluate the reduction of intraarticular fragments and soft tissue injuries. In recent years, volar locking plate fixation has become popular, and arthroscopic procedures for distal radius fracture reduction have become problematic because vertical traction has to be both on and off during surgery. We developed a plate presetting arthroscopic reduction technique to simplify the combination of plating and arthroscopy. The fracture was reduced, and anatomic alignment was regained under an image intensifier, and then the volar locking plate was preset. Wrist arthroscopy was introduced under vertical traction, and the intraarticular condition was assessed. If dislocations of the intraarticular fragments were residual, they were reduced arthroscopically, and soft tissue injuries were treated subsequently. Finally, the traction was removed, and the plate was securely fixed. Since May 2005, the authors have used this technique in more than 50 patients. This article will review the history, indications, contraindications, technique, rehabilitation, and complications for the plate presetting arthroscopic reduction technique for distal radius fractures.
腕关节镜检查用于桡骨远端骨折是评估关节内骨折块复位及软组织损伤情况的一种有效辅助手段。近年来,掌侧锁定钢板固定术已广泛应用,而桡骨远端骨折的关节镜下复位操作变得困难,因为手术过程中必须反复进行垂直牵引。我们研发了一种钢板预设置关节镜下复位技术,以简化钢板固定与关节镜检查的联合操作。先在影像增强器下复位骨折并恢复解剖对线,然后预设置掌侧锁定钢板。在垂直牵引下插入腕关节镜,评估关节内情况。若关节内骨折块仍有移位,则在关节镜下复位,随后处理软组织损伤。最后,去除牵引并牢固固定钢板。自2005年5月以来,作者已将该技术应用于50余例患者。本文将对桡骨远端骨折钢板预设置关节镜下复位技术的历史、适应证、禁忌证、技术操作、康复及并发症进行综述。