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桡骨远端“分水岭（watershed line）”

2022-03-23 Dr. zhang 骨科青年

分水岭
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掌侧锁定接骨板内固定是治疗桡骨远端骨折的金标准，然后接骨板位置不当可能导致屈肌腱激惹甚至肌腱磨损断裂风险。

掌侧锁定接骨板内固定是治疗桡骨远端骨折的金标准，然后接骨板位置不当可能导致屈肌腱激惹甚至肌腱磨损断裂风险。因此，有学者将桡骨远端掌侧理论上最凸起的一条线，称为“分水岭”。

2011年，Soong在JBJS上刊文（DOI: 10.2106/JBJS.J.00193. ），其根据侧位上接骨板与分水岭的位置关系，将桡骨远端接骨板放置位置分为3级。

图片

红线：侧位经桡骨远端最远端凸起的垂线；蓝线：经桡骨远端掌侧皮质的垂线。图A：0级，接骨板位于红线内；图B：1级，接骨板接触红线，但仍位于掌侧皮质近端；图C：2级，接骨板位于掌侧皮质远端。

在Soong的研究中观察到1级接骨板位置会造成更多的肌腱损伤，同时2级虽然没有观察到损伤病例，考虑是钢板低切迹所致，并建议钢板放置在如下标准位置：

图片

但有学者（DOI: 10.1016/j.jhsa.2012.05.011）通过尸体研究发现，桡骨远端掌侧缘存在两条明显凸起的线：

图片

图片

在尺侧半，存在图中黄色和蓝色两条凸起线，在桡侧只有绿色一条凸起线。红色线为旋前方肌的止点线。因此，分水岭应该为尺侧半蓝色线与桡侧半绿色线的连线。

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图片

[参考文献]
[1] Bergsma M, Doornberg JN, Borghorst A, Kernkamp WA, Jaarsma RL, Bain GI. The Watershed Line of the Distal Radius: Cadaveric and Imaging Study of Anatomical Landmarks. J Wrist Surg. 2020 Feb;9(1):44-51. 

[2] Imatani J, Akita K, Yamaguchi K, Shimizu H, Kondou H, Ozaki T. An anatomical study of the watershed line on the volar, distal aspect of the radius: implications for plate placement and avoidance of tendon ruptures. J Hand Surg Am. 2012 Aug;37(8):1550-4.

 

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    2022-09-06 ms9474365431325850

    #SHED#

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    2022-03-24 13d6c0b9m93暂无昵称

    获益匪浅

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    2022-03-24 ms2000001386604039

    学习

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    2022-03-23 ms920641618706883

    #桡骨#

    0

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    2023-01-29 anminleiryan

    #ERS#

    0