术中利用股骨颈正侧位影像判断空心钉导针位置的研究  

Positioning of cannulated screw guide pins by fluoroscopy in the treatment of femoral neck fractures

作　　者：李志杰[1] 田元[1] 赵磊[1] 宋朝晖[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050051

出　　处：《中国骨与关节外科》2012年第6期481-484,共4页Chinese Journal of Bone and Joint Surgery

基　　金：国家科技支撑计划:急救环境下骨创伤智能化微创手术装备研究与应用示范(2011BAF01B05)

摘　　要：背景:空心钉治疗股骨颈骨折是目前临床最常用的方法,由术中正侧位X线透视示空心钉导针均位于股骨头范围内而认为导针未穿出股骨头不可靠,多角度透视影像可避免导针穿出股骨头,但费时费力,使患者及术者受到更多辐射。目的:探讨股骨颈骨折术中透视下空心钉导针尖距离股骨头边缘的安全距离,以防止导针穿出股骨头。方法:统计2011年10月至2012年4月30例股骨颈骨折患者术中股骨颈正侧位影像中空心钉导针在股骨头内的分布情况。根据股骨头近似大半个球体的特点及股骨颈正侧位影像成像原理建立立体几何公式,计算侧位透视下距离股骨颈轴线不同距离的空心钉导针尖在正位透视上应距离股骨头边缘的安全距离,确保导针不穿出股骨头。结果:侧位影像中导针尖距离股骨颈轴线0.2r～0.3r范围内,正位影像中导针尖距离股骨头边缘应>1.3mm;侧位影像中导针尖距离股骨颈轴线0.5r～0.6r范围内,正位影像中导针尖距离股骨头边缘应>5mm;侧位影像中导针尖距离股骨颈轴线0.8r～0.9r范围内,正位影像中导针尖距离股骨头边缘应>14mm。结论:侧位影像中空心钉导针尖位于股骨颈轴线上,正位影像中导针尖位于股骨头范围内导针就不会穿出股骨头。侧位影像中导针尖偏离股骨颈轴线越远,正位影像中导针尖距离股骨头边缘的安全距离越大。Background： Carmulated screw is a popular tool for the treatment of femoral neck fracture. It is possible that cannulated screw guide pins cut out from femoral head, even if the tip of guide pins is in the femoral head on the AP and lateral radio-graph. Although fluoroscopic radiograph can avoid the cut-out, it is time-consuming, laborious and more irradiated. Objective： The aim of the study is to discuss the safe distance from the tip of the cannulated screw guide pin to the edge of the femoral head so as to avoid cut-out of guide pin from femoral head. Methods： From October 2011 to April 2012, 30 patients with femoral neck fracture were surgically treated. The placement of cannulated screw guide pins in the femoral heads on anteroposterior （AP） and lateral views was recorded during treat- ment. According to the characteristic of the femoral head （just like a sphere） and the imaging principle of AP and lateral radiographs of femoral neck, a solid geometry formula was established. The safe distances from the tips of different cannulated screw guide pins to the edge of the femoral head were computed. Results： The mean diameter of femoral head was 49.8 mm. When the distance from the tip of guide pin to the axis of femoral neck was in the range of 0.2 r to 0.3 r on lateral view, the safe distance from the tip of the cannulated screw guide pin to the edge of the femoral head should be more than 1.3 mm on AP view. When the distance from the tip of guide pin to the ax- is of femoral neck was in the range of 0.5 r to 0.6 r on lateral view, the distance should be more than 5 mm on AP view. When the distance from the tip of guide pin to the axis of femoral neck was in the range of 0.8 r to 0.9 r on lateral view, the distance should be more than 14 mm on AP view. Conclusions： If the tip of cannulated screw guide pin is on the axis of femoral neck on lateral view, the guide pin cannot cut out when the tip of guide pin in the femoral head on AP view. The distance on the AP view is greater when the tip of gu

关 键 词：股骨颈骨折 骨折固定术 内 关节穿出 透视 

分 类 号：R687.3[医药卫生—骨科学]