Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
Department of Orthopedics, Buddhachinaraj Hospital, Phitsanulok, 65000, Thailand.
Int Orthop. 2021 Aug;45(8):2111-2119. doi: 10.1007/s00264-021-05063-9. Epub 2021 May 1.
To identify the anatomical relationship between neurovascular structures and screws and to evaluate the danger zone of screw placement during minimally invasive plate osteosynthesis (MIPO) technique following the volar approach for the radius and the subcutaneous approach for the ulna in diaphyseal forearm fractures.
Sixteen cadaveric forearms were fixed with a 3.5-mm, 14-hole, locking compression plate (LCP) using the MIPO technique with a volar approach of the radius. Two locking screws were fixed at each end via two separated incisions, and the remaining ten screws were inserted percutaneously. The same MIPO technique was performed at the ulna with the subcutaneous approach. The forearms were then dissected to identify any damage to or direct contact between the screws and the radial artery (RA), the superficial branch of the radial nerve (SBRN), the posterior interosseous nerve (PIN), and the dorsal cutaneous branch of the ulnar nerve (DCBUN). The distances from the screws to the structures at risk, as well as the radial and ulnar length, were measured.
The average lengths of the radius and ulna were 24.74 cm and 25.93 cm, respectively. On the volar aspect of the radius, the danger zones of RA and SRN were between 15.26 and 81.24% of the length of the radius from the radial styloid. The zone of PIN injury at the posterior aspect of the radius was between 41.45 and 81.24% of the length of the radius from the radial styloid. Meanwhile, the danger zone of DCBUN was between 12.21 and 27.23% of the ulnar length from the ulnar styloid.
Based on our study, the percutaneous screw fixation in MIPO for the treatment of diaphyseal fractures of the forearm is a dangerous procedure, especially for the volar approach of the entire radius and the subcutaneous approach of the distal ulna.
确定桡骨经掌侧入路和尺骨经皮下入路微创钢板接骨术（MIPO）技术中神经血管结构与螺钉的解剖关系，并评估骨干前臂骨折 MIPO 技术中螺钉置入的危险区域。
将 16 具尸体前臂用 3.5mm、14 孔、锁定加压钢板（LCP）固定，采用桡骨掌侧入路 MIPO 技术。通过两个单独的切口在两端各固定两个锁定螺钉，其余十个螺钉经皮插入。尺骨采用皮下入路行同样的 MIPO 技术。然后解剖前臂以确定螺钉与桡动脉（RA）、桡神经浅支（SBRN）、骨间后神经（PIN）和尺神经背侧皮支（DCBUN）之间是否有损伤或直接接触。测量螺钉至危险结构的距离以及桡骨和尺骨的长度。
桡骨和尺骨的平均长度分别为 24.74cm 和 25.93cm。在桡骨掌侧，RA 和 SBRN 的危险区域为桡骨茎突至桡骨长度的 15.26%至 81.24%。桡骨后 PIN 损伤区域为桡骨茎突至桡骨长度的 41.45%至 81.24%。同时，DCBUN 的危险区域为尺骨茎突至尺骨长度的 12.21%至 27.23%。
根据我们的研究，MIPO 治疗骨干前臂骨折的经皮螺钉固定是一种危险的手术，尤其是对于整个桡骨掌侧入路和尺骨远端皮下入路。
