术中桡骨远端背侧切线位及桡侧沟位用于检测掌侧钢板固定时背侧螺钉突出：教学效果及临床应用价值
The Intraoperative Dorsal Tangential and the Radial Groove View of the Distal Radius to Detect Dorsal Screw Protrusion in Volar Plating: Teaching Effect and Value in Clinical Practice.
作者信息
Faessler David, Pozzi Lara, Doert Aleksis, Schlaeppi Michel, Meier Christoph
机构信息
Division for Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Zurich, Switzerland.
Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Zurich, Switzerland.
出版信息
J Hand Surg Glob Online. 2025 May 21;7(4):100734. doi: 10.1016/j.jhsg.2025.100734. eCollection 2025 Jul.
PURPOSE
Dorsal screw tip protrusion (DSTP) with extensor tendon injury is a well-known complication after volar plating of the distal radius. Specific fluoroscopic views such as the dorsal tangential view (DTV) and the radial groove view (RGV) have been recommended to detect DSTP. The aim of this study was to investigate the accuracy of these views before and after standardized teaching of the involved surgeons.
METHODS
All adult patients treated with volar plating of the distal radius between 10/2019 and 09/2020 were included. All involved surgeons were instructed on how to perform accurate DTV and RGV. Patients from an earlier period (07/2018-09/2019) before teaching served as controls. The impact of teaching was assessed. Intraoperative detection of DSTP based on fluoroscopy was documented. DTV and RGV were further evaluated as a set of fluoroscopic investigations and not as individual views. The accuracy of DTV and RGV to detect DSTP was compared with that of postoperative ultrasound.
RESULTS
A total of 124 patients were included in the study group and compared with the control group (n = 125). Interobserver agreement for the image accuracy was 97% for DTV and 98% for RGV, respectively. Correct images were observed for DTV in 81% after standardized teaching versus 58% for the control group and 81% versus 53% for RGV, respectively ( < .001). Intraoperative fluoroscopy detected 24 DSTP in 571 evaluated screws (4.2%) in the study group, most of them affecting the second (n = 11) and fourth (n = 10) extensor compartments. Sensitivity to detect DSTP was 85.7% for DTV and RGV combined. Postoperative ultrasound revealed four DSTP (0.8-1.2 mm; 0.7%) in four patients (3.2%).
CONCLUSIONS
Standardized teaching leads to a significant improvement of appropriate views. DTV and RGV are reliable tools to detect DSTP. However, some minor dorsal cortex penetrations may be missed.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IIb.
目的
桡骨远端掌侧钢板固定术后，背侧螺钉尖端突出（DSTP）伴伸肌腱损伤是一种众所周知的并发症。推荐使用特定的透视视图，如背侧切线视图（DTV）和桡骨沟视图（RGV）来检测DSTP。本研究的目的是调查在对相关外科医生进行标准化教学前后，这些视图的准确性。
方法
纳入2019年10月至2020年9月期间接受桡骨远端掌侧钢板固定治疗的所有成年患者。指导所有相关外科医生如何准确进行DTV和RGV操作。教学前早期（2018年7月至2019年9月）的患者作为对照。评估教学的影响。记录基于透视的术中DSTP检测情况。DTV和RGV作为一组透视检查进行进一步评估，而非单独的视图。将DTV和RGV检测DSTP的准确性与术后超声的准确性进行比较。
结果
研究组共纳入124例患者，并与对照组（n = 125）进行比较。DTV和RGV的图像准确性的观察者间一致性分别为97%和98%。标准化教学后，DTV的正确图像观察率为81%，而对照组为58%；RGV分别为81%和53%（P <.001）。研究组在571枚评估螺钉中，术中透视检测到24例DSTP（4.2%），其中大多数影响第二（n = 11）和第四（n = 10）伸肌间隔。DTV和RGV联合检测DSTP的敏感性为85.7%。术后超声在4例患者（3.2%）中发现4例DSTP（0.8 - 1.2 mm；0.7%）。
结论
标准化教学可显著改善合适视图的情况。DTV和RGV是检测DSTP的可靠工具。然而，可能会遗漏一些轻微的背侧皮质穿透情况。
研究类型/证据水平：诊断性IIb级。
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