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桡骨远端骨折采用掌侧锁定接骨板固定已成共识，但由于桡骨远端背侧存在骨性突起，术中侧位透视存在遮挡，无法有效判断螺钉是否穿出背侧皮质，而螺钉一旦穿透对侧皮质，将会磨损背侧伸肌腱，甚至造成肌腱断裂风险。 因此，如何在通过术中透视，评估锁定螺钉是否穿出背侧皮质显得尤为重要。对此，有学者研究出一种新的透视体位，可直观观察螺钉远端与皮质相对位置，相关结果发表在J Wrist surgery期刊上。
Background（背景） [Background: Open reduction and internal fixation (ORIF) using a volar locking plate is a common method for treating displaced distal radius fractures. There is, however, the risk of extensor tendon rupture due to protrusion of the screw tips past the dorsal cortex, which cannot always be adequately seen on a lateral fluoroscopic view. We therefore wished to compare the sensitivity of an intraoperative fluoroscopic skyline view to a lateral fluorosocopic view in detecting past pointing of these screws.] Material and Methods（方法） 我们的研究包括75名平均年龄为59岁的患者，他们接受了桡骨远端移位骨折的掌侧锁定钢板内固定术。每例患者均行术中前后位、侧位和Skyline透视。侧位和Skyline均记录了螺钉穿出远端骨折碎片背侧皮质的数量。还记录了需要更换的螺钉数量。 [Material and Methods: Our series included 75 patients with an average age of 59 years who underwent volar locked plate fixation of a displaced distal radius fracture. Intraoperative anteroposterior (AP), lateral, and skyline fluoroscopic views were performed in each case. The number of screws that were seen to protrude past the dorsal cortex of the distal fracture fragment were recorded for both the lateral and skyline views. The number of screws that required exchange was also documented.]
图1：Skyline位透视体位摆放图。 Results（结果） 在侧位透视下，没有看到螺钉突出超过背侧骨皮质。300枚螺钉中有15枚(5%)超过背侧皮质平均0.8毫米(范围0.5至2毫米)，11/75的患者更换了较短的螺钉。 [Results: No screws were seen to protrude past the dorsal cortical bone on the lateral fluroscopic views. 15 of 300 screws (5%) were seen to protrude past the dorsal cortex by an average of 0.8 mm (range, 0.5 to 2 mm) and were exchanged for shorter screws in 11/75 patients.]
图2：典型病例1。正侧位（a.b）未见螺钉穿出下尺桡关节或对侧皮质，Skyline位（c）见螺钉穿出（1），更换螺钉后见螺钉未穿出（d）
图3：典型病例2。正侧位（a.b）未见螺钉穿出下尺桡关节或对侧皮质，Skyline位（c）见螺钉穿出（第2枚螺钉），更换螺钉后见螺钉未穿出（d） Conclusion（结论） [Conclusion: Our results demonstrate that the skyline is more sensitive than a lateral fluoroscopic view at demonstrating protrusion of the screws in the distal fracture fragment following volar locked plate fixation.] 文献全文
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