桡骨远端骨折掌侧板固定术后如何选择X线检查（二）

背侧切线位透视

背侧切线位透视可显示桡骨远端背侧皮质和下尺桡关节，判断背侧皮质是否复位，螺钉是否穿出背侧皮质，螺钉是否进入下尺桡关节，下尺桡关节是否复位。

背侧切线位透视投照方法：患者仰卧于手术床，上肢置于水平桌面上，肘关节屈曲75°，前臂最大旋后，腕关节最大掌屈，X线垂直投照[4]。

掌侧切线位透视

掌侧切线位透视可显示桡骨远端背侧皮质和下尺桡关节，判断背侧皮质是否复位，螺钉是否穿出背侧皮质，螺钉是否进入下尺桡关节，下尺桡关节是否复位。

掌侧切线位透视投照方法：患者仰卧于手术床，上肢置于水平桌面上，肘关节屈曲75°，前臂最大旋后，腕关节最大背伸，X线对着鱼际隆起（thenar eminence）垂直投照[9]。掌侧切线位透视可显示桡骨远端背侧皮质和下尺桡关节，腕骨位于桡骨远端背侧皮质上方，当完美显示掌侧接骨板远侧缘时，表示获得了正确的掌侧切线位透视图像。

小结

桡骨远端骨折掌侧接骨板内固定后，①判断桡骨远端关节面是否平整，建议采用切线位正、侧位透视。②判断接骨板是否位于分水岭近侧，建议采用切线位侧位透视。③判断螺钉是否进入桡腕关节，建议采用切线位正、侧位透视。④判断螺钉是否穿出桡骨远端背侧皮质，建议采用旋前45°斜位透视、旋后45°斜位透视和背侧（或掌侧）切线位透视。⑤判断螺钉是否进入下尺桡关节，建议采用背侧（或掌侧）切线位透视。

参考文献

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