中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2866-2870.doi: 10.12307/2023.307

• 骨科植入物 orthopedic implant • 上一篇    下一篇

微调装置辅助下股骨髓内钉远端锁钉的置入效果

刘  旭1,2,陈  浩1,2,孔祥如1,2,姜  伟1,2   

  1. 1南京鼓楼医院集团宿迁医院骨科,江苏省宿迁市   223800;2徐州医科大学附属宿迁医院骨科,江苏省宿迁市   223800
  • 收稿日期:2022-02-25 接受日期:2022-04-26 出版日期:2023-06-28 发布日期:2022-09-17
  • 通讯作者: 姜伟,硕士,主治医师,南京鼓楼医院集团宿迁医院骨科,江苏省宿迁市 223800;徐州医科大学附属宿迁医院骨科,江苏省宿迁市 223800
  • 作者简介:刘旭,男,1985年生,江苏省淮安市人,汉族,2016年南京医科大学毕业,硕士,主治医师,主要从事骨关节、创伤方面的研究。
  • 基金资助:
    2019年度宿迁市指导性科技计划项目(Z2019174),项目名称:股骨转子间骨折髓内钉定位导引器设计及临床应用,项目负责人:陈浩

Insertion of distal interlocking of femoral intramedullary nails with vernier device

Liu Xu1, 2, Chen Hao1, 2, Kong Xiangru1, 2, Jiang Wei1, 2   

  1. 1Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian 223800, Jiangsu Province, China; 2Department of Orthopedics, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian 223800, Jiangsu Province, China
  • Received:2022-02-25 Accepted:2022-04-26 Online:2023-06-28 Published:2022-09-17
  • Contact: Jiang Wei, Master, Attending physician, Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian 223800, Jiangsu Province, China; Department of Orthopedics, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian 223800, Jiangsu Province, China
  • About author:Liu Xu, Master, Attending physician, Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian 223800, Jiangsu Province, China; Department of Orthopedics, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian 223800, Jiangsu Province, China
  • Supported by:
    Suqian Municipal Guiding Science and Technology Project in 2019, No. Z2019174 (to CH)

摘要:

文题释义:
股骨髓内钉徒手置钉技术:利用C形臂透视股骨髓内钉,使远端锁孔重叠成标准正圆,通过调整使得钻头或克氏针的尖端位于正圆中心,调整电钻方向,使钻头或克氏针垂直于正圆的平面,保持住方向,钻孔,即可通过远端锁钉孔。
微调装置辅助下置钉技术:连接微调装置,确认冠状面上套筒对准髓内钉的钉孔;插入套筒,拔除内芯,调整C臂机透视出正圆(C臂机靠近套筒,C臂机的大平面和套筒尾端小平面平行时,容易透出正圆);调整定位杆使得定位杆圆心和髓内钉圆心在一条轴线上,即髓内钉和定位杆共用同一条中轴线;沿套筒插入克氏针,不要切口,直接插至骨皮质,然后锤入;透视确认克氏针在位,钻孔、测深、拧入合适长度螺钉。

背景:髓内钉是治疗股骨干骨折的“金标准”,但股骨髓内钉远端锁钉的置入一直是个难题。
目的:比较微调装置辅助下徒手股骨髓内钉远端锁钉置入与单纯徒手置钉的效果。
方法:纳入2017-2021年南京鼓楼医院集团宿迁医院骨科收治的股骨干、股骨转子部骨折患者63例,共计64侧肢体股骨骨折,采用随机数字表法分为2组:微调装置组(32侧)在微调装置辅助下进行徒手股骨髓内钉远端锁钉置入,徒手操作组(32侧)进行徒手股骨髓内钉远端锁钉置入。比较两组从开始到透视形成正圆图像的时间和透视次数,置钉成功的时间和透视次数,锁钉置入操作的总时间。
结果与结论:微调装置组从开始操作C臂到正圆形成的时间和透视次数少于徒手操作组(P < 0.001),从正圆形成到C臂确认置钉成功的时间和透视次数少于徒手操作组(P < 0.001),锁钉置入操作的总时间少于徒手操作组(P < 0.001)。结果表明,相较于单纯徒手置钉,微调装置辅助置钉速度快、间接辐射少,无直接辐射暴露,无需专门设计装置,是值得推广的一项锁钉技术。

https://orcid.org/0000-0002-8668-2860 (刘旭) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 股骨骨折, 髓内钉, 锁钉置入, 内固定, 微调装置, 徒手置钉, 磁力导航, 体外瞄准架

Abstract: BACKGROUND: Intramedullary nail is the “gold standard” for the treatment of femoral shaft fractures, but the placement of distal locking of the femoral intramedullary nail has always been a difficult problem.  
OBJECTIVE: To compare the effectiveness between unarmed and vernier device support groups for distal interlocking screws in femoral nails.
METHODS: Totally 63 patients with femoral shaft and trochanteric fractures (64 sides) were enrolled from Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital from 2017 to 2021. They were randomly divided into two groups. In the vernier device support group (32 cases), unarmed femoral intramedullary nail placement and internal fixation were conducted with vernier device support. In the unarmed group (32 cases), unarmed femoral intramedullary nail distal locking screw placement and internal fixation were conducted. The operation time and X-ray count for a perfect circle image, the time and the number of fluoroscopy when the nail was successfully placed, and the total time of the locking nail insertion were compared between unarmed and vernier device support groups.  
RESULTS AND CONCLUSION: The operation time and X-ray count for a perfect circle image of the vernier device support group were less than those in the unarmed group (P < 0.001). The time and the number of fluoroscopy when the nail was successfully placed of the vernier device support group were less than those in the unarmed group (P < 0.001). The total time of the locking nail insertion of the vernier device support group was less than that in the unarmed group (P < 0.001). The results show that, compared with the unarmed nail placement, the vernier device support placement has faster locking speed, less indirect radiation, no direct radiation exposure, and no need for a specially designed device. It is a locking nail technology worthy of promotion.

Key words: femoral fracture, intramedullary nail, interlocking screw, internal fixation, vernier device, unarmed nailing, magnetic navigation, extracorporeal diopter

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