术中侧斜位 X线检查在桡骨远端骨折 40例的应用价值

目的术中通过附加侧斜位 X线检查观察桡骨远端螺钉与腕关节面的关系，从而评价桡骨远端骨折术后临床疗效。方法对 2018年 1月至 2020年 2月芜湖市第一人民医院桡骨远端骨折的 40例病人行切开复位锁定钢板内固定，术中常规拍摄正侧位 X线片，附加侧斜位 X线检查，保证锁定钢板远端螺钉未进入腕关节面，通过测量术后即刻、术后 3个月及末次随访时掌倾角、尺偏角及桡骨高度，观察术后并发症及评估末次随访时腕关节功能(采用 Dienst腕关节评分标准)，从而评价其临床疗效。结果所有病人均获得随访，随访 8~12个月，平均 10.6个月。术后即刻、术后 3个月及末次随访掌倾角、尺偏角及桡骨高度差异无统计学意义( P>0.05)。术后均无内固定松动、断裂发生，无拇长屈肌腱断裂、创伤性关节炎、无畸形愈合及关节僵硬的发生，末次随访时腕关节功能评估为优 29例，良 10例，可 1例，优良率为 97.5%。结论术中侧斜位 X线检查可以保证远端锁钉不进入腕关节腔，可以尽可能地将钢板放置骨折远端，使骨折远端固定更加牢固，从而避免术后掌倾角、尺偏角及桡骨高度的丢失，临床疗效满意。

The clinical value of lateral oblique X-ray examination in 40 cases of distal radius fractures

Objective To observe the relationship between distal radial screws and wrist articular surface by taking lateral oblique X-ray films during the operation, so as to evaluate the postoperative clinical efficacy of distal radial fractures.Methods Totally 40 patients with distal radial fractures were treated by open reduction and internal fixation with plates and screws in The First People''s Hospital of Wuhu City from January 2018 to February 2020. The anterior and lateral films were routinely taken during the operation, andthe lateral oblique film was attached to ensure that the distal screw of the locking plate did not enter the wrist articular surface. By measuring the palm dip angle, ulnar angle and radius height immediately after the operation, at postoperative 3 months and at the last follow-up, the postoperative complications were observed and wrist joint function at the last follow-up was evaluated using Dienst wrist function grading system, so as to evaluate its clinical efficacy.Results All the patients were followed up from 8 to 12 months with anaverage of 10.6 months. There were no statistically significant differences in the palm dip angle, ulnar angle and radius height immediately after the operation, at postoperative 3 months and at the last follow-up (P>0.05). No internal fixation loosening or breakage, or flexor pollicis tendon rupture, traumatic arthritis, malunion or joint stiffness were found after operation. At the last follow-up, wrist functionwas evaluated as excellent in 29 cases, good in 10 cases, and good in 1 case, with an excellent and good rate of 97.5%.Conclusion The addition of lateral oblique X-ray examination can ensure that the distal locking nail does not enter the wrist articular surface. Inthis way, the plate can be placed at the distal end of the fracture as far as possible during the operation to make the distal fracture morefirmly fixed, so as to reduce the loss of the palm dip angle, ulnar angle and radius height, with satisfactory clinical efficacy.