掌侧锁定接骨板固定是桡骨远端关节外骨折最常用方法，桡骨远端骨折目的是恢复掌倾角、尺偏角及桡骨高度，通过利用解剖钢板的解剖弧度，先固定远折端骨块后借助钢板复位，已被众多研究者证实为可靠的方法。但该技术存在的一个难点为如何将钢板置入在准确位置，因钢板位置偏差可能导致重复复位置钉的风险。因此有学者使用了一种新的钢板定位方法，取得良好效果，结果发表在近期Injury上。

Abstract

掌侧钢板是治疗桡骨远端背侧移位关节外骨折最常用的手术方法之一。然而，恢复掌倾角有时间是困难的。其通常需要进行手腕屈曲动作，同时保持、拧紧钢板，过程比较繁琐。

而钢板定位也是其中一个关键的步骤，由于钢板的尺寸相对于桡骨远端的宽度很大，其定位也有时较为困难。

我们在复位前置入远端所有螺钉，然后我们利用锁定板的解剖形状，通过用皮质加压螺钉将桡骨近端固定到钢板上减少背倾。为了确保板的方便、准确定位，我们以徒手方式在分水岭线近端10毫米和距掌侧骨皮质内侧缘外侧10毫米处钻一个导向孔，而不定位板。这样可以清楚地看到导向孔的位置。然后在单皮质非锁定螺钉的帮助下将锁定板固定于桡骨远端，并且在透视下对其进行控制。当导向孔被正确定位并且板在前后方向上位置良好时，剩余的远端螺钉孔置入锁定螺钉。然后用双皮质加压螺钉将钢板固定在桡骨近端，从而减少桡骨背倾。我们认为这种技术是一种安全和可重复的方法来定位掌侧钢板，并在解剖学上减少关节外移位桡骨远端骨折(AO A2和A3)的背倾。此外，该技术提供的骨折制动复位减少了手术时间和辐射。

图1 暴露骨折远断端。

图2 在分水岭近端10mm，距桡骨内侧皮质边缘10mm钻导向孔。

图3 导向孔示意图。

图4 通过导向孔置钉，确保钢板位置妥当。

图5 确定钢板位置妥当后，将远骨折端锁定，利用解剖板弧度复位，近端加压螺钉固定。

图6 另一典型病例图。

[Aim:Volar plating is one of the most used surgical treatments for dorsally displaced extra-articular distal radius fractures. However, the reduction of the dorsal tilt can be difficult. It usually requires a flexion maneuver of the wrist while maintaining and screwing the plate, which is cumbersome. Plate positioning also is a crucial step and is sometimes difficult because of the large size of the plate relative to the width of the distal radius. We use an epiphysis-first technique. We place all the epiphyseal screws before reduction, and then we take advantage of the anatomical shape of a locking plate to automatically reduce the dorsal tilt by fixing the proximal radius to the plate with cortical compression screws. To ensure easy and accurate positioning of the plate, we drill a distal medial pilot hole in a free-hand fashion 10 mm proximal to the watershed line and 10 mm lateral to the medial rim of the radius, without positioning the plate. This allows a clear view of the location of this first hole. The locking plate is then applied to the distal radius with help of a monocortical non-locking screw, and it is controlled under fluoroscopy. When this medial pilot hole is properly positioned and the plate correctly tilted on the anteroposterior view, the remaining epiphyseal holes are filled with locking screws. Then the plate is fixed on the proximal radius with bicortical compression screws, allowing an automatic reduction of the epiphyseal dorsal tilt. We believe this technique is a safe and reproducible way to position volar plates and to reduce anatomically the dorsal tilt in extra-articular posteriorly displaced distal radius fractures (AO A2 and A3). Furthermore, the automatic fracture reduction provided by this technique decreases operation time and radiation.]