腕背切线位透视在桡骨远端骨折掌侧万向锁定接骨板固定术中的应用  

Application of dorsal wrist tangential fluoroscopy in fixation of volar locking plate for distal radius fractures

作　　者：庞波涛 刘永涛[1] 宋坤修[1] 马丙栋[1] 张政[1] 李雪城 邓志洋 PANG Botao;LIU Yongtao;SONG Kunxiu(Department of Hand Microsurgery,Binzhou Medical University Hospital,Binzhou,Shandong,256603,China)

机构地区：[1]滨州医学院附属医院手显微外科,山东滨州256603

出　　处：《实用手外科杂志》2020年第2期145-148,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨腕背切线位透视在桡骨远端骨折掌侧万向锁定接骨板固定术中的应用价值。方法2018年4月-2019年4月,应用第三代AO万向掌侧双柱锁定加压接骨板固定治疗新鲜桡骨远端骨折28例。手术均采用掌侧改良Henry入路,术中接骨板完成后常规在正位及侧位切线位透视基础上进行腕背切线位透视,明确无螺钉穿出背侧皮质及进入下尺桡关节;术后常规行CT扫描并由第三方临床骨科专家进行影像学评价。术后6周及3、6、12个月复查X线片并检查腕关节活动及功能恢复情况。末次随访时采用Gartland-Werley评分评估腕关节功能。结果术中经腕背切线位透视发现问题5例,阳性率17.9%。28例患者均获得随访,随访时间6~18个月,平均13.5个月。所有患者均获得骨性愈合,愈合时间8~10周,术后无切口感染、无内固定松动、无内固定断裂、无肌腱断裂。经第三方临床骨科专家术后影像学评价,满意26例,不满意2例,满意率92.9%。末次随访时Gartland-Werley评分为0~7分,平均2.5分,优23例,良5例(原因为腕关节疼痛及活动受限)。结论术中于腕背切线位透视监视下,可以使桡骨远端锁定螺钉的置入更安全更有效,使掌侧万向双柱锁定接骨板发挥出最大的功效,有效避免并发症的同时可实现早期功能康复训练及快速康复,值得临床应用。Objective To evaluate the application value of dorsal wrist tangential fluoroscopy in the fixation of distal radius fractures with volar locking plates.Methods From April 2018 to April 2019,28 cases of fresh distal radius fractures were treated with the third-generation AO volar double-column locking plates.All the operations were performed though modified Henry’s approach.After the fixation,we performed dorsal carpal tangent fluoroscopy so as to make sure that no screw was inserted out of the dorsal cortex and into the DRUJ.CT scans was performed routinely and imaging evaluation was performed by third-party clinical orthopedic experts.X-ray examination was performed at 6 weeks and 3,6,12 months after operation to observe fracture healing.At the last follow-up,the gartland-werley score was used to evaluate wrist function.Results 5 cases were revealed problems by the intraoperative dorsal tangent fluoroscopy with the positive rate of 17.9%.All 28 patients were followed up for 3 to 15 months(10.5 months on average).All the patients healed,with an average healing time of 8 to 10 weeks.No infection,loose internal fixation,fracture of internal fixation or tendon rupture were found after the operation.The evaluation of postoperative imaging by third-party clinical orthopedic experts was satisfactory in 26 cases and unsatisfactory in 2 cases,with a satisfaction rate of92.9%.At the last follow-up,the gartland-werley score was 0~7,with an average of 2.5 points.23 cases were excellent and 5 cases were good due to wrist pain and limited movement.Conclusion Under the monitoring of intraoperative dorsal wrist tangent perspective,the placement of the distal radial locking screw can be safer and more effective,which can maximize the effect of the volar double-column locking plates,effectively avoid complications and enable patients to achieve early functional exercise and rapid recovery,which is worthy of clinical application.

关 键 词：桡骨远端骨折 骨折固定术 锁定接骨板 X线透视检查 

分 类 号：R687.3[医药卫生—骨科学]