桡骨远端骨折术中切线位透视检测螺钉穿出的研究--.docx
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1、桡骨远端骨折术中切线位透视检测螺钉穿出的研究 中图分类号R274.11;文献标识码A;文章編号1674-4721(2019)2(a)-0133-04 AbstractObjectiveToexplorethesensitivityandspecificityoftangentialfluoroscopyindetectingscrewperforationindistalradiusfractures.MethodsFromJanuary2016toSeptember2017,patientswithdistalradiusfracturetreatedbyopenreductionandvo
2、larplateinternalfixationinourhospitalwereselectedanddividedintotwogroupsaccordingtothefollowingtwocriteriaaccordingtointraoperativefluoroscopy.Atotalof131patientswithsuspiciousperforationofdistalradiusscrewthroughthearticularsurfacewereselectedastheanterolateralincisiongroupbystandardanterolateralfl
3、uoroscopy,andthentheanterolateralincisionfluoroscopyofdistalradiuswasperformed.Atotalof115patientswithsuspiciousscrewpenetrationthroughthedorsalcortexwereselectedasthedorsalincisiongroupbystandardlateralfluoroscopy,andthenthedistalradiusdorsalincisionfluoroscopywasperformed.Three-dimensionalCTscanso
4、fwristjointswereperformedinbothgroupsabout3daysafteroperation.Thesensitivityandspecificityoftheanterolateralanddorsalcutswereanalyzed.Atthesametime,accordingtotheresultsofthree-dimensionalCTscans,thenumberofscrewpenetratingthedorsalcortexwascalculated,andwhichquadrantthescrewpenetratingthedorsalcort
5、exwaslocated.ResultsThesensitivityandspecificityofthetangentialpositionfordetectingthenon-perforatedandperforatedarticularsurfacesofthescrewwere98.26%and81.25%respectivelyinthepositiveandlateralincisiongroup,accordingtoGartland-WerleyWristFunctionScore,theexcellentandgoodratewas79.05%.Thesensitivity
6、andspecificityoftangentialscrewdetectioninthedorsalsectiongroupwere99.01%and85.71%respectively,whichdidnotpenetratethedorsalcortexandpenetratedthedorsalcortex.Atotalof441distalradiusscrewswereinsertedintothedistalrow(i.e.nearthearticularsurface).ThescrewpositionswerescannedbyCT:thefirstroom(48,10.88
7、%),thesecondroom(144,32.65%),38,thethirdroom(163,36.96%),0,thefourthroom(86,19.50%)and9.ConclusionThetangentpositionishighlyreliableforjudgingthescrewpenetratingthearticularsurfaceandthedorsalcortexofthedistalradiusfractur.Thescrewpenetratingthedorsalcortexismainlylocatedinthesecondandfourthcompartm
8、ents,whichhascertainguidingsignificanceforjudgingthelengthofthescrewduringtheoperation.KeywordsDistalradialfracture;Tangentialposition;Screw桡骨远端骨折是上肢的一种多发骨折,对有移位、粉碎性并累及关节面或潜在不稳定骨折,通常采用切开复位掌侧钢板螺钉内固定1。由于桡骨远端自身的骨性解剖特点,术中X线影像常显示螺钉进入关节或者穿透背侧骨皮质,导致术者误判,从而改变钢板螺钉的位置及螺钉的长度,不能达到最佳地固定效果,假如背侧螺钉过长会激惹拇长伸肌等背伸肌,导致术
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- 桡骨 远端 骨折 切线 透视 检测 螺钉 研究
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