桡骨远端骨折内固定术中两透视方式比较△

Comparison of two fluoroscopy position in internal fixation of distal radius fractures

摘要:

[目的] 探讨桡骨远端骨折掌侧钢板内固定术中行腕管位透视 （carpal shoot through view, CSTV） 与背侧切线位透视 （dorsal tangential view, DTV）的应用效果。[方法]2019 年 1 月—2023 年 1 月，50 例桡骨远端骨折患者纳入本研究。依据术前医患沟通结果，分为 CSTV 组和 DTV 组，每组 25 例。比较两组临床与影像结果。[结果]两组手术时间、切口长度、术中失血量差异均无统计学意义（P＞0.05）。随访时间平均（12.7±3.4）个月，末次随访，两组患者腕伸-屈 ROM、桡-尺偏 ROM、Gart- land-Werley 评分差异均无统计学意义 （P＞0.05）。影像方面，CSTV 组透视次数 [(1.9±0.8) 次 vs (2.7±1.2) 次, P=0.008] 显著少于 DTV 组。两组术中穿透钉检出率的差异无统计学意义（P＞0.05）。两组均无穿透钉漏检者。[结论]掌侧钢板内固定治疗桡骨远端骨折术中行 CSTV 和 DTV 均能有效检测出穿出桡骨远端背侧皮质螺钉，CSTV 组透视次数少于 DTV 组。

Abstract:

[Objective] To investigate the clinical efficacy of carpal shoot through view (CSTV) and dorsal tangential view (DTV) of fluoroscopy during open reduction and internal fixation (ORIF) with plate for distal radius fractures. [Methods] From January 2019 to January 2023, 50 patients with distal radius fractures were included in this study. According to the preoperative doctor-patient communication, the patients were divided into CSTV group and DTV group, with 25 cases in each group. Clinical and imaging data were compared between the two groups. [Results] There were no significant differences in operation time, incision length and intraoperative blood loss between the two groups (P＞0.05). At the last follow-up lasted for a mean of (12.7±3.4) months, there were no significant differences in wrist extension-flexion range of motion (ROM), radio-ulnar deviation ROM and Gartland-Werley scores between the two groups (P＞0.05). In term of imaging, the fluoroscopy times in CSTV group were significantly less than that in DTV group [(1.9±0.8) vs (2.7±1.2), P=0.008]. There was no a significant difference in the detection rate of penetrating screw between the two groups (P＞0.05), and no penetrating screw was missed in both groups. [Conclusion] Both CSTV and DTV positions can effectively detect the screw penetrating the dorsal cortex of the distal radius during ORIF of distal radius fracture with palmar plate, however, the fluoroscopy times in CSTV group is less than that in DTV group.