Brent D Bates, Jonathan Persitz, Atefeh Noori, Andrea H W Chan, Ryan A Paul
{"title":"在接受桡骨远端畸形骨折矫正截骨术的患者中验证提拉螺钉技术","authors":"Brent D Bates, Jonathan Persitz, Atefeh Noori, Andrea H W Chan, Ryan A Paul","doi":"10.1016/j.jhsa.2024.07.025","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to validate the clinical accuracy of the lift-off screw (LOS) technique for volar tilt correction (VTC) in patients undergoing corrective osteotomy for dorsally angulated distal radius fracture malunions.</p><p><strong>Methods: </strong>We conducted a retrospective review of 23 patients with dorsally angulated distal radius fracture malunions treated with corrective osteotomy using the LOS technique. The LOS equation L<sub>s</sub> = [tan(T<sub>c</sub>) ∗ L<sub>p</sub> + C]/[cos(⍬<sub>s</sub>)] and standardized intraoperative fluoroscopic images were used to determine and compare the calculated and clinical VTC and final volar tilt. Correlations between the LOS length and the clinical VTC were calculated, as well as between the desired VTC and the correction accuracy.</p><p><strong>Results: </strong>Preoperative volar tilt ranged from -6° to -50° (mean = -22.9° ± 10.6°). The calculated VTC was 32.7° ± 9.4°, and the clinical VTC achieved was 25.8° ± 9.3°. The difference between the clinical and calculated correction was -6.9°, with an average postoperative clinical volar tilt of 2.8° ± 5.7°, compared with a calculated volar tilt of 9.7° ± 4.4°. There was a moderately strong positive correlation between LOS screw length and clinical VTC achieved, and a moderately weak negative correlation between the desired amount of correction and the accuracy of the correction.</p><p><strong>Conclusions: </strong>The LOS technique is a reproducible method to plan the amount of sagittal plane correction during corrective osteotomy surgery for dorsally angulated distal radius fracture malunions. We demonstrate that this technique underestimates the clinical correction achieved by an average of 7°, with larger deformities experiencing greater undercorrection. Undercorrection of volar tilt during corrective osteotomy should be anticipated by surgeons and considered in future implant and cutting guide designs.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Validation of the Lift-Off Screw Technique in Patients Undergoing Corrective Osteotomy for Malunited Distal Radius Fractures.\",\"authors\":\"Brent D Bates, Jonathan Persitz, Atefeh Noori, Andrea H W Chan, Ryan A Paul\",\"doi\":\"10.1016/j.jhsa.2024.07.025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The purpose of this study was to validate the clinical accuracy of the lift-off screw (LOS) technique for volar tilt correction (VTC) in patients undergoing corrective osteotomy for dorsally angulated distal radius fracture malunions.</p><p><strong>Methods: </strong>We conducted a retrospective review of 23 patients with dorsally angulated distal radius fracture malunions treated with corrective osteotomy using the LOS technique. The LOS equation L<sub>s</sub> = [tan(T<sub>c</sub>) ∗ L<sub>p</sub> + C]/[cos(⍬<sub>s</sub>)] and standardized intraoperative fluoroscopic images were used to determine and compare the calculated and clinical VTC and final volar tilt. Correlations between the LOS length and the clinical VTC were calculated, as well as between the desired VTC and the correction accuracy.</p><p><strong>Results: </strong>Preoperative volar tilt ranged from -6° to -50° (mean = -22.9° ± 10.6°). The calculated VTC was 32.7° ± 9.4°, and the clinical VTC achieved was 25.8° ± 9.3°. The difference between the clinical and calculated correction was -6.9°, with an average postoperative clinical volar tilt of 2.8° ± 5.7°, compared with a calculated volar tilt of 9.7° ± 4.4°. 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Undercorrection of volar tilt during corrective osteotomy should be anticipated by surgeons and considered in future implant and cutting guide designs.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>\",\"PeriodicalId\":54815,\"journal\":{\"name\":\"Journal of Hand Surgery-American Volume\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery-American Volume\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jhsa.2024.07.025\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jhsa.2024.07.025","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的:本研究的目的是验证对桡骨远端骨折背侧成角畸形进行矫正截骨术的患者采用提离螺钉(LOS)技术进行体侧倾斜矫正(VTC)的临床准确性:我们对 23 例桡骨远端骨折背侧成角畸形患者进行了回顾性研究,这些患者均接受了使用 LOS 技术进行的矫正截骨术。我们使用 LOS 方程 Ls = [tan(Tc) ∗ Lp + C]/[cos(⍬s)] 和标准化术中透视图像来确定并比较计算和临床 VTC 以及最终的桡骨外侧倾斜度。计算了 LOS 长度与临床 VTC 之间的相关性,以及预期 VTC 与校正精度之间的相关性:术前的体侧倾斜度从-6°到-50°不等(平均值=-22.9° ± 10.6°)。计算得出的 VTC 为 32.7° ± 9.4°,临床达到的 VTC 为 25.8° ± 9.3°。临床校正与计算校正之间的差值为-6.9°,术后平均临床侧倾为 2.8° ± 5.7°,而计算侧倾为 9.7° ± 4.4°。LOS螺钉长度与临床达到的VTC之间呈中等强度的正相关,而预期矫正量与矫正准确度之间呈中等强度的负相关:LOS技术是一种可重复的方法,用于在桡骨远端骨折背侧成角畸形的矫正截骨手术中规划矢状面矫正量。我们证明,该技术平均低估了 7° 的临床矫正效果,畸形较大时矫正不足的程度更高。外科医生在进行矫正性截骨手术时,应预料到会出现侧倾矫正不足的情况,并在未来的植入物和切割导板设计中加以考虑:治疗 IV.
Validation of the Lift-Off Screw Technique in Patients Undergoing Corrective Osteotomy for Malunited Distal Radius Fractures.
Purpose: The purpose of this study was to validate the clinical accuracy of the lift-off screw (LOS) technique for volar tilt correction (VTC) in patients undergoing corrective osteotomy for dorsally angulated distal radius fracture malunions.
Methods: We conducted a retrospective review of 23 patients with dorsally angulated distal radius fracture malunions treated with corrective osteotomy using the LOS technique. The LOS equation Ls = [tan(Tc) ∗ Lp + C]/[cos(⍬s)] and standardized intraoperative fluoroscopic images were used to determine and compare the calculated and clinical VTC and final volar tilt. Correlations between the LOS length and the clinical VTC were calculated, as well as between the desired VTC and the correction accuracy.
Results: Preoperative volar tilt ranged from -6° to -50° (mean = -22.9° ± 10.6°). The calculated VTC was 32.7° ± 9.4°, and the clinical VTC achieved was 25.8° ± 9.3°. The difference between the clinical and calculated correction was -6.9°, with an average postoperative clinical volar tilt of 2.8° ± 5.7°, compared with a calculated volar tilt of 9.7° ± 4.4°. There was a moderately strong positive correlation between LOS screw length and clinical VTC achieved, and a moderately weak negative correlation between the desired amount of correction and the accuracy of the correction.
Conclusions: The LOS technique is a reproducible method to plan the amount of sagittal plane correction during corrective osteotomy surgery for dorsally angulated distal radius fracture malunions. We demonstrate that this technique underestimates the clinical correction achieved by an average of 7°, with larger deformities experiencing greater undercorrection. Undercorrection of volar tilt during corrective osteotomy should be anticipated by surgeons and considered in future implant and cutting guide designs.
期刊介绍:
The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.