Matullo Kristofer S, Dennison David G
Mayo Clinic, Rochester, MN, USA.
J Hand Surg Am. 2010 Jun;35(6):900-4. doi: 10.1016/j.jhsa.2010.03.010. Epub 2010 May 15.
Lateral tilt (radially inclined) radiographs are useful after volar locked plate fixation of distal radius fractures to assess the radiocarpal joint, subchondral bone congruity, and volar tilt. The purpose of our study was to define the reliability of our positioning method using the patient's opposite hand to position the injured wrist to obtain an inclined lateral radiograph with good visualization of the subchondral bone.
A retrospective review identified adult patients who had a unilateral distal radius fracture treated with a volar locked plate and who had an initial postoperative lateral tilt radiograph using the contralateral hand to position the injured wrist. Intraoperative fluoroscopic images were reviewed to confirm the ability to see the extra-articular placement of all hardware. The inclined lateral wrist radiograph was obtained by positioning the injured wrist at a height determined by the contralateral hand being placed under the ulnar wrist crease. The wrist was then supported there with firm blocks in all cases. The radiographic beam was directed perpendicular to the horizontal cassette. Two reviewers (authors) then blindly reviewed postoperative radiographs to determine whether the radiocarpal joint and subchondral bone were visualized and whether any screws or pegs appeared to cross the radiocarpal joint. An acceptable lateral tilt radiograph was defined as good visualization of the subchondral bone while allowing only the most radial peg to appear to cross the joint. We also placed 15 normal volunteers into the lateral tilt position, using their opposite hand, to measure the inclined forearm angle.
A total of 24 wrists (24 patients) were identified and 23 patients had lateral tilt radiographs with acceptable visualization of the subchondral bone. The concordance of the subchondral bone visualization was 100% (95% confidence interval, 85.5% to 100%). The mean angle with lateral tilt positioning was 18 degrees from horizontal (range, 15 degrees to 23 degrees; standard deviation, 2.4 degrees).
Using the contralateral hand to position the lateral inclined view, our lateral tilt position produced radiographs with reliable visualization of the distal radius subchondral bone in 96% of our cases. Visualization of the subchondral bone in the region of the radial aspect of the scaphoid fossa requires more tilt than is achieved with this technique.
对于桡骨远端骨折掌侧锁定钢板固定术后，侧倾（径向倾斜）位X线片有助于评估桡腕关节、软骨下骨的一致性及掌倾角。本研究的目的是确定使用患者对侧手来摆放受伤手腕以获取能良好显示软骨下骨的倾斜侧位X线片的定位方法的可靠性。
一项回顾性研究纳入了成年单侧桡骨远端骨折并接受掌侧锁定钢板治疗且术后初期使用对侧手摆放受伤手腕获得侧倾位X线片的患者。回顾术中透视图像以确认能否看到所有内固定物的关节外放置情况。通过将受伤手腕置于由对侧手放在尺侧腕横纹下方所确定的高度来获得倾斜的腕关节侧位X线片。在所有病例中，然后用稳固的垫块在该位置支撑手腕。X线射束垂直于水平暗盒。然后两名阅片者（作者）盲法阅片，以确定桡腕关节和软骨下骨是否清晰可见，以及是否有螺钉或骨栓似乎穿过桡腕关节。一张可接受的侧倾位X线片定义为软骨下骨清晰可见，同时仅最桡侧的骨栓似乎穿过关节。我们还让15名正常志愿者用对侧手摆成侧倾位，以测量倾斜的前臂角度。
共确定了24个手腕（24例患者），23例患者的侧倾位X线片软骨下骨显示良好。软骨下骨显示情况的一致性为100%（95%置信区间，85.5%至100%）。侧倾定位的平均角度与水平成18度（范围，15度至23度；标准差，2.4度）。
使用对侧手摆放侧倾位，我们的侧倾位在96%的病例中产生了能可靠显示桡骨远端软骨下骨情况的X线片。舟状窝桡侧区域软骨下骨的显示需要比该技术所达到的更大倾斜度。
