[在桡骨远端骨折的腕关节钢板内固定术中应用改进的腕关节射穿视图]。

Q3 Medicine
Hengshan Liu, Kangquan Shou, Gaobo Zhu
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引用次数: 0

摘要

目的方法:回顾性分析2020年1月至2023年1月期间符合入选标准的67例桡骨远端骨折患者的临床资料:回顾性分析 2020 年 1 月至 2023 年 1 月期间符合入选标准的 67 例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(18-75 岁)。从受伤到手术的时间为2至6天,平均为3.8天。手术中进行了双侧皮质钻孔,植入螺钉的长度比深度尺测量的长度短 1-2 毫米。外侧解剖锁定钢板固定后,分别进行标准的前后侧方(AAL)透视和 ICSTV 透视。如果发现桡骨远端背侧皮质被穿透,则更换短螺钉并再次进行ICSTV透视,直到没有螺钉被穿透为止。比较了AAL透视和ICSTV透视对螺钉穿透桡骨背侧皮质的检出率。术后进行CT扫描以确认是否存在背侧皮质螺钉穿透:术中AAL透视发现4例患者(6.0%)有5枚螺钉穿透背侧皮质,ICSTV透视发现包括上述4例患者在内的15例患者(22.4%)有19枚螺钉穿透背侧皮质,两种透视方法的检出率差异显著[OR=0.267 (0.084, 0.845),P=0.018];15例患者术中更换了短螺钉。同时,ICSTV透视发现有2例(3.0%)患者的2枚螺钉穿入桡肘远端关节,这在AAL透视中无法发现,因此调整了螺钉的方向并进行了更换。所有患者均在术后 3 天内接受了腕部 CT 复查,均未发现背侧皮质螺钉穿入或螺钉穿入桡肘远端关节。所有 67 名患者均接受了 6-18 个月的随访,平均随访时间为 11.3 个月。2 名患者在术后 3 个月出现了伸肌腱刺激症状,所有患者在随访期间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。没有发生内固定松动或骨折移位等并发症。最后一次随访时的 Gartland-Werley 评分从 0 到 15 分不等,平均为 5.6 分:ICSTV透视可有效检测出AAL透视无法显示的桡骨远端隐匿性背侧皮质螺钉穿透。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Application of improved carpal shoot through view in volar plate internal fixation of distal radius fractures].

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 [ OR=0.267 (0.084, 0.845), P=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.

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来源期刊
中国修复重建外科杂志
中国修复重建外科杂志 Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
11334
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