Halvachizadeh Sascha, Berk Till, Pieringer Alexander, Ried Emanuael, Hess Florian, Pfeifer Roman, Pape Hans-Christoph, Allemann Florin
Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Harald-Tscherne Research Laboratory, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
J Clin Med. 2020 Jul 16;9(7):2254. doi: 10.3390/jcm9072254.
It is currently unclear whether the additional effort to perform an intraoperative computed tomography (CT) scan is justified for articular distal radius fractures (DRFs). The purpose of this study was to assess radiological, functional, and clinical outcomes after surgical treatment of distal radius fractures when using conventional fluoroscopy vs. intraoperative CT scans.
Inclusion criteria: Surgical treatment of DRF between 1 January 2011 and 31 December 2011, age 18 and above. Group distribution: intraoperative conventional fluoroscopy (Group Conv) or intraoperative CT scans (Group CT).
Use of different image intensifier devices or incomplete data. DRF classification according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Outcome variables included requirement of revision surgeries, duration of surgery, absorbed radiation dose, and requirement of additional CT scans during hospitalization.
A total of 187 patients were included (Group Conv = 96 (51.3%), Group CT = 91 (48.7%)). AO Classification: Type A fractures = 40 (50%) in Group Conv vs. = 16 (17.6%) in Group CT, < 0.001; Type B: 10 (10.4%) vs. 11 (12.1%), not significant (n.s.); Type C: 38 (39.6%) vs. 64 (70.3%), < 0.001. In Group Conv, four (4.2%) patients required revision surgeries within 6 months, but in Group CT no revision surgery was required. The CT scan led to an intraoperative screw exchange/reposition in 23 (25.3%) cases. The duration of the initial surgery (81.7 ± 46.4 min vs. 90.1 ± 43.6 min, n.s.) was comparable. The radiation dose was significantly higher in Group CT (6.9 ± 1.3 vs. 2.8 ± 7.8 mGy, < 0.001). In Group Conv, 11 (11.5%) patients required additional CT scans during hospitalization.
The usage of intraoperative CT was associated with improved reduction and more adequate positioning of screws postoperatively with comparable durations of surgery. Despite increased efforts by utilizing the intraoperative CT scan, the decrease in reoperations may justify its use.
目前尚不清楚对于桡骨远端关节内骨折（DRF），进行术中计算机断层扫描（CT）扫描所付出的额外努力是否合理。本研究的目的是评估在使用传统透视与术中CT扫描的情况下，桡骨远端骨折手术治疗后的放射学、功能和临床结果。
纳入标准：2011年1月1日至2011年12月31日期间接受DRF手术治疗，年龄18岁及以上。分组：术中传统透视（传统组）或术中CT扫描（CT组）。
使用不同的影像增强器设备或数据不完整。根据骨科学术协会（AO）分类对DRF进行分类。结果变量包括翻修手术的需求、手术持续时间、吸收辐射剂量以及住院期间额外CT扫描的需求。
共纳入187例患者（传统组=96例（51.3%），CT组=91例（48.7%））。AO分类：A 型骨折：传统组40例（50%），CT组16例（17.6%），<0.001；B型：10例（10.4%）对11例（12.1%）,无显著差异（n.s.）；C型：38例（39.6%）对64例（70.3%），<0.001。在传统组中，4例（4.2%）患者在6个月内需要进行翻修手术，但CT组无需翻修手术。CT扫描导致23例（25.3%）病例术中进行螺钉更换/重新定位。初次手术持续时间相当（81.7±46.4分钟对90.1±43.6分钟，n.s.）。CT组的辐射剂量显著更高（6.9±1.3对2.8±7.8毫戈瑞，<0.001）。在传统组中，11例（11.5%）患者在住院期间需要额外的CT扫描。
术中使用CT与术后复位改善和螺钉定位更合适相关，手术持续时间相当。尽管使用术中CT扫描增加了工作量，但再次手术的减少可能证明其使用的合理性。
