PDF(Pubmed)
Abstract：
Background Volar locking plate fixation (VLP) is commonly used to treat distal radius fractures (DRF). Risk of dorsal compartment injury with distal screw hole fixation has been studied; however, the risk with proximal screw hole fixation is not well studied. Purpose The goal of this study was to investigate the risk of dorsal structure injury from the screw holes proximal to the two distal rows. Methods Nine cadaveric forearms were used. After volar distal radius exposure, a long VLP was applied. Kirschner wires were placed through the most proximal holes into the dorsal compartments. The extensor structures penetrated were noted and tagged with hemoclips. The distance from the dorsal cortex to the structures was measured. Results The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscle bodies were only penetrated; no tendons were penetrated. Proportion of muscle penetration increased with the more proximal screw holes. EPB was more likely to be penetrated distally and APL proximally; both were injured at holes 2 and 3. The extensors were 2 mm from the dorsal cortex of the radius on average; this did not decrease with compression of the forearm. Conclusions This is the first study to examine the anatomic risk of extensor structure injury with VLP proximal screw hole penetration. No extensor tendons were penetrated by these proximal screw holes; first dorsal compartment muscle bellies may be irritated with overpenetration. Our findings suggest that proximal VLP screws do not need to be downsized if they are not over 2 mm prominent.
摘要：
背景掌侧锁定钢板内固定(VLP)通常用于治疗桡骨远端骨折(DRF)。已经研究了远端螺钉孔固定的背侧隔室损伤的风险；然而，近端螺钉孔固定的风险没有得到很好的研究。目的本研究的目的是调查从两个远端排的近端螺钉孔的背侧结构损伤的风险。方法使用9具尸体前臂。掌侧桡骨远端暴露后，应用了长VLP。克氏针穿过最近的孔进入背侧隔室。注意到穿透的伸肌结构并用hemoclips标记。测量从背侧皮质到结构的距离。结果长肌外展肌（APL）和短伸肌（EPB）肌体仅被穿透；没有肌腱被穿透。随着近端螺钉孔的增加，肌肉穿透的比例增加。EPB更有可能从远端和近端穿透APL；两者都在第2孔和第3孔受伤。伸肌平均距桡骨的背皮质2毫米；这并没有随着前臂的压缩而减少。结论这是首次研究VLP近端螺钉孔穿透导致伸肌结构损伤的解剖学风险。这些近端螺钉孔没有穿透伸肌肌腱；过度刺入可能会刺激第一背室肌腹。我们的发现表明，如果近端VLP螺钉不超过2mm，则不需要缩小尺寸。
