桡骨远端骨折术中切线位透视检测螺钉穿出的研究(1)
[摘要]目的 探讨桡骨远端骨折术中切线位透视检测螺钉穿出的敏感性和特异度。方法 收集2016年1月～2017年9月在我院行桡骨远端骨折切开复位掌侧钢板内固定的患者，根据术中透视情况，按以下两种标准入选并分为两个组。①术中选择经过标准正侧位透视显示桡骨远端螺钉可疑穿破关节面患者共131例为正侧切位组，然后行桡骨远端正侧切线位透视;②术中选择经过标准侧位透视显示可疑螺钉穿出背侧皮质患者115例为背切位组，然后行桡骨远端背切位透视。以上两组患者均于术后3 d左右行腕关节三维CT检查，然后分别分析正侧切位和背切位的敏感性和特异度，同时根据三维CT扫描结果计算一共有多少螺钉穿出背侧皮质，其中穿出背侧皮质的螺钉又分别位于哪个象限。结果 ①正、侧切位组中切线位检测螺钉未穿破关节面及穿破关节面的敏感性和特异度分别是98.26%、81.25%，根据Gartland-Werley腕关节功能评分表，优良率达79.05%;②背切位组中切线位检测螺钉未穿出背侧皮质及穿出背侧皮质的敏感性和特异度分别是99.01%、85.71%，其中桡骨远端一共打入远排(即靠近关节面)螺钉441枚，经过CT扫描螺钉位置：第1间室(48，10.88%)，穿出0个，第2间室(144，32.65%)，穿出38枚，第3间室(163，36.96%)，穿出0个，第4间室(86，19.50%)，穿出9枚。结论 切线位判断桡骨远端骨折螺钉穿破关节面及穿出背侧皮质具有高度的可靠性;螺钉穿出背侧皮质主要位于第2、4间室，对术中螺钉长度的判断有一定的指导意义。
[关键词]桡骨远端骨折;切线位;螺钉
[中图分类号] R274.11 [文献标识码] A [文章編号] 1674-4721(2019)2(a)-0133-04
[Abstract] Objective To explore the sensitivity and specificity of tangential fluoroscopy in detecting screw perforation in distal radius fractures. Methods From January 2016 to September 2017， patients with distal radius fracture treated by open reduction and volar plate internal fixation in our hospital were selected and divided into two groups according to the following two criteria according to intraoperative fluoroscopy. ①A total of 131 patients with suspicious perforation of distal radius screw through the articular surface were selected as the anterolateral incision group by standard anterolateral fluoroscopy， and then the anterolateral incision fluoroscopy of distal radius was performed. ②A total of 115 patients with suspicious screw penetration through the dorsal cortex were selected as the dorsal incision group by standard lateral fluoroscopy， and then the distal radius dorsal incision fluoroscopy was performed. Three-dimensional CT scans of wrist joints were performed in both groups about 3 days after operation. The sensitivity and specificity of the anterolateral and dorsal cuts were analyzed. At the same time， according to the results of three-dimensional CT scans， the number of screw penetrating the dorsal cortex was calculated， and which quadrant the screw penetrating the dorsal cortex was located. Results ①The sensitivity and specificity of the tangential position for detecting the non-perforated and perforated articular surfaces of the screw were 98.26% and 81.25% respectively in the positive and lateral incision group， according to Gartland-Werley Wrist Function Score， the excellent and good rate was 79.05%. ②The sensitivity and specificity of tangential screw detection in the dorsal section group were 99.01% and 85.71% respectively， which did not penetrate the dorsal cortex and penetrated the dorsal cortex. A total of 441 distal radius screws were inserted into the distal row (i.e. near the articular surface). The screw positions were scanned by CT： the first room (48， 10.88%)， the second room (144， 32.65%)， 38， the third room (163， 36.96%)， 0， the fourth room (86， 19.50%) and 9. Conclusion The tangent position is highly reliable for judging the screw penetrating the articular surface and the dorsal cortex of the distal radius fractur. The screw penetrating the dorsal cortex is mainly located in the second and fourth compartments， which has certain guiding significance for judging the length of the screw during the operation., 百拇医药(王俊鸿 肖志满 刘斌伟)
[关键词]桡骨远端骨折;切线位;螺钉
[中图分类号] R274.11 [文献标识码] A [文章編号] 1674-4721(2019)2(a)-0133-04
[Abstract] Objective To explore the sensitivity and specificity of tangential fluoroscopy in detecting screw perforation in distal radius fractures. Methods From January 2016 to September 2017， patients with distal radius fracture treated by open reduction and volar plate internal fixation in our hospital were selected and divided into two groups according to the following two criteria according to intraoperative fluoroscopy. ①A total of 131 patients with suspicious perforation of distal radius screw through the articular surface were selected as the anterolateral incision group by standard anterolateral fluoroscopy， and then the anterolateral incision fluoroscopy of distal radius was performed. ②A total of 115 patients with suspicious screw penetration through the dorsal cortex were selected as the dorsal incision group by standard lateral fluoroscopy， and then the distal radius dorsal incision fluoroscopy was performed. Three-dimensional CT scans of wrist joints were performed in both groups about 3 days after operation. The sensitivity and specificity of the anterolateral and dorsal cuts were analyzed. At the same time， according to the results of three-dimensional CT scans， the number of screw penetrating the dorsal cortex was calculated， and which quadrant the screw penetrating the dorsal cortex was located. Results ①The sensitivity and specificity of the tangential position for detecting the non-perforated and perforated articular surfaces of the screw were 98.26% and 81.25% respectively in the positive and lateral incision group， according to Gartland-Werley Wrist Function Score， the excellent and good rate was 79.05%. ②The sensitivity and specificity of tangential screw detection in the dorsal section group were 99.01% and 85.71% respectively， which did not penetrate the dorsal cortex and penetrated the dorsal cortex. A total of 441 distal radius screws were inserted into the distal row (i.e. near the articular surface). The screw positions were scanned by CT： the first room (48， 10.88%)， the second room (144， 32.65%)， 38， the third room (163， 36.96%)， 0， the fourth room (86， 19.50%) and 9. Conclusion The tangent position is highly reliable for judging the screw penetrating the articular surface and the dorsal cortex of the distal radius fractur. The screw penetrating the dorsal cortex is mainly located in the second and fourth compartments， which has certain guiding significance for judging the length of the screw during the operation., 百拇医药(王俊鸿 肖志满 刘斌伟)