| Objective To explore the optimal perspective of modified Skyline fluoroscopy and its application value in volar plate internal fixation for patients with distal radius fracture.MethodsThis experiment is divided into two parts,the first part is the cadaver sample experiment,the second part is the clinical experiment.1.Twenty cadaver forearm specimens were randomly selected as the research objects,and the experiment was carried out by simulating the clinical treatment method of volar plate internal fixation of the distal radius.All operations were performed with a volar approach between the flexor carpi radialis muscle and the radial artery to expose the bone,and internal fixation was performed with a volar anatomical plate of the distal radius.The nail holes were all bilateral cortical bone holes.The standard depth ruler was used to measure the depth of the nail holes,and the corresponding length of the screw fixation plate was selected.After fixation,improved SKYLINE fluoroscopy method was adopted,and "mobile C-arm X-ray machine" was used to fluoroscopy the cadaval specimens for many times to find the best perspective and obtain the image data.At the same time,standard anteroposterior and lateral fluoroscopy were performed on the same specimen to obtain image data.The protruding screws detected intraoperatively were replaced until no screws were detected protruding from the dorsal cortex of the distal radius.Finally,the cadaveric specimen was dissected and the dorsal distal radius was observed under direct vision to see if there were screws penetrating the bone cortex.2.From October 2019 to October 2020,90 patients with fresh distal radius fractures treated with volar anatomical plate internal fixation alone were enrolled in this study,including 36 males and 54 females.Age 16--81 years old.Patients included in the study were cross-selected(1:1)according to admission time and divided into control group and experimental group.Using the above approaches and methods,patients in the control group received intraoperative fluoroscopy by standard forward and lateral methods,and postoperative fluoroscopy by modified Skyline fluoroscopy.In the experimental group,intraoperative fluoroscopy was performed using standard anteroposterior,lateral,and modified Skyline fluoroscopy,and screws penetrating the dorsal cortex were replaced intraoperatively until no screws penetrating the dorsal cortex were detected.The screw penetration of the dorsal cortical bone of the distal radius in the experimental group was compared under the two detection methods,and statistical processing was performed.The operative time,intraoperative blood loss,fracture healing time,wrist function recovery,and complications of dorsal extensor tendon stimulation were compared between the experimental group and the control group,and statistical treatment was performed.ResultsLine in the specimen of the distal radius volar anatomic plate fixation,by adopting the method of improved Skyline perspective,it is concluded that the method in "elbows close to the radiation source,wrist joints close to the radiation to accept screen,forearm and 15 ° Angle and wrist joints as far as possible to the radiation palm bow out 15 ° Angle",found a total of 9(9/20)cases the condition of the screw through the specimen;Standard anteroposterior and lateral fluoroscopy was performed,and no specimen with screw penetration was found.After intraoperative replacement of the over-long screw,the modified Skyline fluoroscopy was performed again,and the replaced screw was found not to have penetrated the dorsal cortical bone of the distal radius.Upon dissection of the specimen,it was confirmed that there were no screws penetrating the dorsal cortex of the distal radius.Groups(neutral,oblique perspective found 2(4.44%,2/45)of patients with distal radius dorsal have screw,found in intraoperative modified Skyline perspective method of perspective,including the above two cases,21(46.67%,21/45)of patients with distal radius dorsal screw wear out,two methods of perspective screw,the results of detection results there were significant differences.The fracture classification and composition of patients in the experimental group and the control group were different.The chi-square test showed that there was no significant difference in the statistical results between the two groups.The operation time(minutes)required for the control group and the experimental group were44.53±11.63 and 45.2±11.28,respectively,and there was no statistical difference between the two groups.The intraoperative blood loss(ml)in the control group and the experimental group was 20(15-20)and 20(20-27.5),respectively,and there was no statistical difference between the two groups.The fracture healing time(weeks)in the control group and the experimental group was 9.93±1.63 and 10.24±1.93,respectively,and there was no statistical difference between the two groups.There was no statistical difference in the recovery of wrist function between the control group and the experimental group.The symptoms of carpal dorsal tendon stimulation were 0 in the control group and 6(13.33%)in the experimental group,respectively,and there was a statistically significant difference between the two groups.ConclusionThe improved Skyline fluoroscopy method can obtain relatively satisfactory image data when the forearm is at an Angle of 15°and the wrist is flexion and external rotation at an Angle of15°when the elbow is near the radiation source and the wrist is near the radiation receiving screen.Through improved Skyline perspective method for intraoperative fluoroscopy,compared with only using standard positive,side perspective,can effectively find the distal radius dorsal if there is a screw through the bone cortex,dorsal and screw in operation for the replacement,is likely to reduce wrist dorsal extensor tendon irritability,wear and fracture of the incidence of complications such as play a positive role. |
PDF Full Text Request