Duncan Jacob, Trzeciak Marc
1 Valley Orthopedic Surgery Residency, Modesto, CA, USA.
Hand (N Y). 2018 May;13(3):341-345. doi: 10.1177/1558944717701239. Epub 2017 Mar 30.
The Conventus Distal Radius System (DRS) is an intramedullary fixation scaffold inserted into the lateral aspect of the distal radius. The purpose of this study was to identify insertion site anatomy to illustrate risks associated with the minimally invasive nature of radial-sided implant application.
Ten cadavers were utilized. Using fluoroscopy, the 1.1-mm Kirschner wire and template was introduced per manufacturer's guidelines, access guide assembled, and dissection carried out to the superficial radial nerve (SRN) with preservation of the native location. The access guide marked the insertion location for the side-cut drill. This point was measured in relationship to structures nearby, including the SRN, brachioradialis (BR), lateral antebrachial cutaneous nerve (LABCN), and radial styloid (RS).
The large guide contacted the SRN in 4 of 10 cadavers and was volar to it in 6 of 10. When volar, the mean distance was 1.7 mm. The tip of the RS to the large access guide averaged 44.5 mm. The small guide contacted the SRN in 2 of 10, was volar to it in 4 of 10, and between the bifurcation in 4 of 10. When volar, the distance averaged 3.25 mm. When bifurcated, the distance from the small guide to both the dorsal and volar branches was 3.5 mm. The distance from the RS to the small guide averaged 37.8 mm. The LABCN was found in the field of dissection in 4 of 10 cadavers.
Several structures are at risk during insertion of the Conventus DRS; thus, knowledge of the relevant anatomy of this minimally invasive approach is crucial to optimize outcomes and patient satisfaction, and to avoid nerve injury.
Conventus桡骨远端系统(DRS)是一种插入桡骨远端外侧的髓内固定支架。本研究的目的是确定插入部位的解剖结构,以阐明与桡侧植入物微创应用相关的风险。
使用了10具尸体。按照制造商的指南,通过荧光透视引入1.1毫米克氏针和模板,组装入路导向器,并在保留原位的情况下解剖至桡浅神经(SRN)。入路导向器标记了侧切钻的插入位置。测量该点与附近结构的关系,包括SRN、肱桡肌(BR)、前臂外侧皮神经(LABCN)和桡骨茎突(RS)。
在10具尸体中,大型导向器在4具中接触到SRN,在10具中的6具中位于其掌侧。当位于掌侧时,平均距离为1.7毫米。RS尖端到大型入路导向器的平均距离为44.5毫米。小型导向器在10具中的2具中接触到SRN,在10具中的4具中位于其掌侧,在10具中的4具中位于分叉处之间。当位于掌侧时,距离平均为3.25毫米。当分叉时,小型导向器到背侧和掌侧分支的距离均为3.5毫米。RS到小型导向器的平均距离为37.8毫米。在解剖区域中,10具尸体中有4具发现了LABCN。
在Conventus DRS插入过程中,有几个结构存在风险;因此,了解这种微创方法的相关解剖结构对于优化手术效果和患者满意度以及避免神经损伤至关重要。