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改良腕关节穿通位片在桡骨远端骨折掌侧钢板内固定中的应用

[Application of improved carpal shoot through view in volar plate internal fixation of distal radius fractures].

作者信息

Liu Hengshan, Shou Kangquan, Zhu Gaobo

机构信息

Department of Emergency and Trauma, Yichang Central People's Hospital, the First College of Clinical Medical Science, China Three Gorges University, Yichang Hubei, 443003, P. R. China.

Department of Orthopedics, Yichang Central People's Hospital, the First College of Clinical Medical Science, China Three Gorges University, Yichang Hubei, 443003, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Aug 15;38(8):976-980. doi: 10.7507/1002-1892.202401100.

Abstract

OBJECTIVE

To explore the application of improved carpal shoot through view (ICSTV) method in the treatment of distal radius fractures with volar plate internal fixation.

METHODS

The clinical data of 67 patients with distal radius fractures who met the selection criteria between January 2020 and January 2023 was retrospectively analyzed. There were 30 males and 37 females with an average age of 53.6 years (range, 18-75 years). According to the AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 25 cases of type B and 42 cases of type C. The time from injury to operation ranged from 2 to 6 days, with an average of 3.8 days. During the operation, bilateral cortical drilling was performed, and the length of the implanted screw was 1-2 mm shorter than that measured by the depth ruler. Standard anteroposterior and lateral (AAL) fluoroscopy and ICSTV fluoroscopy were performed after volar anatomic locking plate fixation, respectively. If the dorsal cortex of the distal radius was detected to be penetrated, the short screw was replaced and ICSTV fluoroscopy was performed again until no screw was penetrated. The detection rate of dorsal cortical screw penetration was compared between AAL fluoroscopy and ICSTV fluoroscopy. Postoperative CT scan was performed to confirm the presence or absence of dorsal cortical screw penetration.

RESULTS

Intraoperative AAL fluoroscopy found 5 screws penetrating the dorsal cortex in 4 patients (6.0%), and ICSTV fluoroscopy found 19 screws penetrating the dorsal cortex in 15 patients (22.4%) including the above 4 patients, with a significant difference in the detection rate between the two fluoroscopy methods [ =0.267 (0.084, 0.845), =0.018]; 15 patients were replaced with short screws during operation. At the same time, ICSTV fluoroscopy detected 2 screws penetrating into the distal radioulnar joint in 2 cases (3.0%), which could not be found in AAL fluoroscopy, and the direction of the screws was adjusted and replaced. All patients were reexamined by wrist CT within 3 days after operation, and no dorsal cortical screw penetration or screw penetration into the distal radioulnar joint was found. All the 67 patients were followed up 6-18 months, with an average of 11.3 months. Extensor tendon irritation occurred in 2 patients at 3 months after operation, and no extensor tendon rupture occurred in all patients during follow-up. All fractures healed well, and the healing time was 8-13 weeks, with an average of 10.8 weeks. There was no complication such as internal fixation loosening or fracture displacement. The Gartland-Werley score at last follow-up ranged from 0 to 15, with an average of 5.6.

CONCLUSION

ICSTV fluoroscopy can effectively detect occult dorsal cortical screw penetration of the distal radius that can not be revealed by AAL fluoroscopy.

摘要

目的

探讨改良腕关节穿通视图(ICSTV)法在桡骨远端骨折掌侧钢板内固定治疗中的应用。

方法

回顾性分析2020年1月至2023年1月间67例符合入选标准的桡骨远端骨折患者的临床资料。其中男性30例,女性37例,平均年龄53.6岁(范围18 - 75岁)。根据AO/骨科创伤协会(AO/OTA)分类,B型25例,C型42例。受伤至手术时间为2 - 6天,平均3.8天。手术中进行双侧皮质钻孔,植入螺钉长度比深度尺测量值短1 - 2 mm。掌侧解剖锁定钢板固定后分别行标准正侧位(AAL)透视和ICSTV透视。若检测到桡骨远端背侧皮质被穿透,则更换短螺钉并再次行ICSTV透视,直至无螺钉穿透。比较AAL透视和ICSTV透视对背侧皮质螺钉穿透的检测率。术后行CT扫描以确认是否存在背侧皮质螺钉穿透。

结果

术中AAL透视发现4例患者5枚螺钉穿透背侧皮质(6.0%),ICSTV透视发现包括上述4例患者在内的15例患者19枚螺钉穿透背侧皮质(22.4%),两种透视方法检测率差异有统计学意义[ =0.267(0.084, 0.845), =0.018];15例患者术中更换为短螺钉。同时,ICSTV透视检测到2例患者2枚螺钉穿入下尺桡关节(3.0%),AAL透视未发现,调整螺钉方向并更换。所有患者术后3天内行腕关节CT复查,未发现背侧皮质螺钉穿透或螺钉穿入下尺桡关节。67例患者均获随访6 - 18个月,平均11.3个月。术后3个月2例患者出现伸肌腱激惹,随访期间所有患者均未发生伸肌腱断裂。所有骨折均愈合良好,愈合时间为8 - 13周,平均10.8周。未出现内固定松动或骨折移位等并发症。末次随访时Gartland - Werley评分0 - 15分,平均5.6分。

结论

ICSTV透视能有效检测出AAL透视无法显示的桡骨远端隐匿性背侧皮质螺钉穿透情况。

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Avoiding screw overlength using dorsal horizon view in palmar plate osteosynthesis of distal radius fractures: a prospective randomized trial.
Arch Orthop Trauma Surg. 2024 Jan;144(1):197-204. doi: 10.1007/s00402-023-05046-y. Epub 2023 Sep 19.
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