腕关节四位片术中透视联合桡骨远端掌侧“T”型万向锁定钛板内固定应用于桡骨远端骨折的疗效研究

Study on the effect of intraoperative fluoroscopy of wrist joint combined with volar"T"type universal locking titanium plate internal fixation for distal radius fractures

目的:观察腕关节四位片术中透视联合桡骨远端掌侧“T”型万向锁定钛板内固定应用于桡骨远端骨折的疗效。方法:回顾性分析行切开复位锁定钢板内固定治疗的42例桡骨远端骨折病例,手术均采用Henry入路,术中均行腕关节四位片透视(标准正侧位、侧位切线位和腕掌屈切线位),明确螺钉有无进入关节腔、下尺桡关节及穿出桡骨远端背侧皮质,所有病人术后常规行腕关节CT三维重建检查,进行影像学评估。比较桡骨远端骨折术前术后骨折复位质量情况,比较术前及末次随访时Cooney腕关节功能评分,比较术中腕关节正侧位及四位片问题螺钉检出率。结果:所有病人手术时间45~90 min,手术出血量20~100 mL,手术切口均临床一期愈合,无切口感染、钢板外露等并发症。末次随访时Cooney腕关节功能评分优良率明显高于术前(P<0.01)。治疗后病人的桡骨高度、掌倾角及尺偏角均明显大于治疗前(P<0.01)。正侧位透视与四位片透视问题螺钉检出率比较差异有统计学意义(P<0.01)。术中所有问题螺钉均予以及时调整,术后复查腕关节三维CT发现42例病例中1例病人桡侧柱一枚螺钉突破背侧皮质约2 mm,后期随访未出现背侧肌腱激惹症状。结论:桡骨远端掌侧“T”型万向锁定钛板应用于桡骨远端骨折,可以取得满意的骨折复位和较好的临床疗效,病人可以实现快速康复锻炼。

Objective:To study the effect of intraoperative fluoroscopy of wrist joint combined with internal fixation of volar"T"type universal locking titanium plate on distal radius fracture.Methods:A retrospective analysis was made on 42 cases of distal radius fractures treated with open reduction and locking plate internal fixation.Henry′s approach was adopted for the operation.Four position fluoroscopy of wrist joint(standard anteroposterior lateral position,lateral tangent position and carpometacarpal flexion tangent position)was performed during the operation to determine whether the screws entered the joint cavity,lower radioulnar joint and penetrated the dorsal cortex of distal radius.All patients underwent routine three-dimensional CT reconstruction of wrist joint after the operation,and imaging evaluation was performed.The quality of fracture reduction before and after the operation of distal radius fracture was compared,the Cooney wrist function score before the operation and at the last follow-up was compared,and the detection rate of the screws with problems in the anteroposterior and lateral positions of the wrist joint and the four position films during the operation was compared.Results:All patients had a surgical time of 45-90 minutes,a surgical bleeding volume of 20-100 mL,and all surgical incisions healed clinically in the first stage.There were no complications such as incision infection or steel plate exposure.At the last follow-up,the excellent and good rate of Cooney wrist joint function score was significantly higher than before surgery(P<0.01).After treatment,the radius height,palm inclination angle,and ulnar deviation angle of the patient were significantly higher than before treatment(P<0.01).There was a statistically significant difference in the detection rate of screw problems between anteroposterior and lateral fluoroscopy and four position X-ray fluoroscopy(P<0.01).All problematic screws during the surgery were promptly adjusted.Postoperative three-dimen sional CT examination of the wrist revealed that in one of the 42 cases,a screw in the radial column penetrated the dorsal cortex by about 2 mm.No symptoms of dorsal tendon irritation were observed during follow-up.Conclusions:The application of"T"type universal locking titanium plate at the volar side of the distal radius in the treatment of distal radius fractures can achieve satisfactory fracture reduction and better clinical effect.Patients can achieve rapid rehabilitation exercise.