背景:关节螺钉穿刺是舟骨骨折固定后最常见的硬件相关问题之一,发生在三分之二的患者中,特别是在肩峰梯形(STT)关节中。这项研究的目的是调查是否可以使用标准的前后(AP)和外侧,以及使用直接开放式可视化和放大镜作为参考标准的其他非标准荧光透视图。
方法:本影像学研究使用10个新鲜尸体腕部。将长度为24mm的2.2mm空心压缩螺钉放置在舟骨中,并逐渐在STT关节处突出2mm。然后通过旋转前臂使用测角测量获得手腕的八个透视图,保持图像束平行于地板:(1)手腕在中性旋转的前后,(2)尺骨偏中腕关节前后,(3)从中性斜60°仰斜(60°仰斜),(4)从中性斜45°仰斜(45°仰斜),(5)一个真正的横向,(6)真实的横向与手腕在径向上有偏差,(7)内翻斜距中性45°(内翻斜45°),和(8)与中性倾斜60°的内旋倾斜(60°的内旋倾斜)。
结果:经皮空心螺钉内固定舟骨骨折的标准前后和外侧透视视图(影像学校准)不足以检测远端关节穿透,缺少当前研究中螺钉穿透量的一半。发现45°内旋斜视在检测STT穿透方面最敏感(p<0.0001)。
结论:经皮空心螺钉内固定术治疗舟骨腰部骨折的标准前后路和外侧透视检查结果不足以检测STT螺钉穿刺。根据目前的研究,标准视图将错过螺钉穿透量的一半,这似乎反映了这个问题在当前实践中的高发率。最敏感的视图是45°内旋斜视,在所有情况下都检测到STT螺钉穿透。证据水平不适用。
BACKGROUND: Articular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically important issue could be detected using standard anteroposterior (AP) and lateral, as well as additional nonstandard fluoroscopic views using direct open visualization with magnifying loupes as reference standard.
METHODS: Ten fresh cadaver wrists were used for this imaging study. A 2.2 mm cannulated compression screws with a length of 24 mm was placed in the scaphoid and incrementally left to protrude at the STT joint up to 2 mm. Eight fluoroscopic views of the wrist were then obtained by rotating the forearm using goniometric measurements, keeping the image beam parallel to the floor: (1) anteroposterior with the wrist in neutral rotation, (2) anteroposterior with the wrist in ulnar deviation, (3) supinated oblique 60° from neutral (60° supinated oblique), (4) supinated oblique 45° from neutral (45° supinated oblique), (5) a true lateral, (6) a true lateral with the wrist in radial deviation, (7) pronated oblique 45° from neutral (45° pronated oblique), and (8) a pronated oblique 60° from neutral (60° pronated oblique).
RESULTS: Standard anteroposterior and lateral fluoroscopy views (radiographically calibrated) of a percutaneous cannulated screw fixation of a scaphoid fracture were insufficient to detect distal articular penetration, missing half the amount of screw penetrations in the current study. The 45° pronated oblique view was found as the most sensitive in detecting STT penetration (p < 0.0001).
CONCLUSIONS: Standard anteroposterior and lateral fluoroscopy views of a percutaneous cannulated screw fixation of a scaphoid waist fracture are insufficient to detect STT screw penetration. According to the current study, standard views would have missed half the amount of screw penetrations, which seems to reflect the high incidence of this problem in current practice. The most sensitive view was the 45° pronated oblique view, which detected STT screw penetration in all cases. Level of Evidence Not applicable.