术中桡骨远端背侧切向和桡骨远端槽位观察掌侧钢板中螺钉突出：教学效果及临床应用价值

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-05-21 DOI:10.1016/j.jhsg.2025.100734

David Faessler MD , Lara Pozzi MD , Aleksis Doert MD , Michel Schlaeppi MSc , Christoph Meier MD

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引用次数: 0

摘要

目的：桡骨远端掌侧钢板固定后，背侧螺钉尖端突出伴伸肌腱损伤是常见的并发症。特定的透视视图，如背切线视图（DTV）和径向槽视图（RGV）已被推荐用于检测DSTP。本研究的目的是调查这些观点的准确性之前和之后的标准化教学的外科医生。方法选取2019年10月至2020年9月期间接受桡骨远端掌侧钢板治疗的所有成人患者。所有参与的外科医生都被指导如何进行准确的DTV和RGV。在教学前较早时期（2018年7月至2019年9月）的患者作为对照。对教学效果进行了评估。术中基于透视检测DSTP被记录。DTV和RGV作为一组透视检查进一步评估，而不是作为单独的观点。比较DTV和RGV与术后超声检测DSTP的准确性。结果研究组共纳入124例患者，与对照组（n = 125）进行比较。观察者间对DTV和RGV图像精度的一致性分别为97%和98%。标准化教学后DTV的正确率为81%，对照组为58%，RGV为81%，RGV为53% (P <；措施)。术中透视检查在研究组571枚评估螺钉（4.2%）中检测到24颗DSTP，其中大多数影响第二（n = 11）和第四（n = 10）伸肌间室。DTV和RGV联合检测DSTP的灵敏度为85.7%。术后超声示4个DSTP (0.8-1.2 mm；0.7%)， 4例（3.2%）。结论规范化教学显著提高了学生的正确观点。DTV和RGV是检测DSTP的可靠工具。然而，一些次要的背皮层穿透可能会被遗漏。研究类型/证据水平

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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

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 (P < .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.