标准视图不足以评估远端舟状骨关节插管螺钉的穿透情况。

IF 3 2区 医学 Q1 ORTHOPEDICS
Pierre-Emmanuel Chammas, Maxime Pastor, Michel Chammas, Geert Alexander Buijze
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引用次数: 0

摘要

背景:关节螺钉穿透是舟状骨骨折固定术后最常见的硬件相关问题之一,多达三分之二的患者会出现这种问题,尤其是进入舟状骨-三尖瓣骨(STT)关节。本研究的目的是研究是否可以使用标准前后(AP)和侧位,以及使用放大镜作为参考标准的直接开放可视化的额外非标准荧光透视图来检测这一临床重要问题。材料与方法:本研究选用10具新鲜手腕尸体进行影像学研究。将长度为24mm的2.2mm套管加压螺钉放置在舟骨中,并逐渐向左突出STT关节达2mm。然后,通过使用角度测量旋转前臂,保持图像束平行于地板,获得手腕的八个荧光透视图:(1)手腕前后中立旋转,(2)手腕前后尺侧偏斜,(3)从中立角度60°的仰卧斜位(60°仰卧斜位),(4)与中性点成45°的旋后斜角(45°旋后斜角),(5)真外侧,(6)手腕径向偏斜的真外侧,和(8)与中性线成60°的内斜视(60°内斜视)。结果:舟骨骨折经皮套管螺钉固定的标准前后侧荧光透视图(射线照相校准)不足以检测远端关节穿透,遗漏了当前研究中螺钉穿透量的一半。45°内旋斜视是检测STT穿透最敏感的(p 结论:经皮套管螺钉内固定治疗腕舟骨腰部骨折的标准前后侧透视图不足以检测STT螺钉的穿透情况。根据目前的研究,标准视图会错过一半的螺钉穿透量,这似乎反映了当前实践中该问题的高发生率。最敏感的视图是45°内旋斜视图,在所有病例中都能检测到STT螺钉穿透。证据级别不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration.

Background: Articular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically important issue could be detected using standard anteroposterior (AP) and lateral, as well as additional nonstandard fluoroscopic views using direct open visualization with magnifying loupes as reference standard.

Materials and methods: Ten fresh cadaver wrists were used for this imaging study. A 2.2 mm cannulated compression screws with a length of 24 mm was placed in the scaphoid and incrementally left to protrude at the STT joint up to 2 mm. Eight fluoroscopic views of the wrist were then obtained by rotating the forearm using goniometric measurements, keeping the image beam parallel to the floor: (1) anteroposterior with the wrist in neutral rotation, (2) anteroposterior with the wrist in ulnar deviation, (3) supinated oblique 60° from neutral (60° supinated oblique), (4) supinated oblique 45° from neutral (45° supinated oblique), (5) a true lateral, (6) a true lateral with the wrist in radial deviation, (7) pronated oblique 45° from neutral (45° pronated oblique), and (8) a pronated oblique 60° from neutral (60° pronated oblique).

Results: Standard anteroposterior and lateral fluoroscopy views (radiographically calibrated) of a percutaneous cannulated screw fixation of a scaphoid fracture were insufficient to detect distal articular penetration, missing half the amount of screw penetrations in the current study. The 45° pronated oblique view was found as the most sensitive in detecting STT penetration (p < 0.0001).

Conclusions: Standard anteroposterior and lateral fluoroscopy views of a percutaneous cannulated screw fixation of a scaphoid waist fracture are insufficient to detect STT screw penetration. According to the current study, standard views would have missed half the amount of screw penetrations, which seems to reflect the high incidence of this problem in current practice. The most sensitive view was the 45° pronated oblique view, which detected STT screw penetration in all cases. Level of Evidence Not applicable.

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来源期刊
Journal of Orthopaedics and Traumatology
Journal of Orthopaedics and Traumatology Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
0.00%
发文量
56
审稿时长
13 weeks
期刊介绍: The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.
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