可透视的下肢托架设计及其在下肢髓内钉内固定手术中的应用  

Design and application of lower limb radiolucent bracket for tibial and femoral fractures internal fixation by intramedullary nail

作　　者：王骏飞[1] 熊进[1] 陈一心[1] 施鸿飞[1] 邱旭升[1] 郑欣[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,江苏南京210008

出　　处：《现代医学》2014年第11期1274-1277,共4页Modern Medical Journal

基　　金：南京市医学重点科技发展项目(ZKX12016);江苏省科技发展项目(BE20116004);南京市医药卫生科研课题(YKK13079)

摘　　要：目的:探讨可透视的下肢托架设计方法及其应用于下肢髓内钉内固定手术的效果。方法:选择31例下肢骨折患者,平均年龄37.6岁,分别行股骨倒打髓内钉(9例)和胫骨髓内钉(22例)内固定术,在术中透视测量插入主钉时膝关节屈曲角。根据插入主钉时膝关节屈曲的最适角度,设计并制作可透视的下肢托架。再选择倒打股骨髓内钉固定患者29例,平均年龄39.4岁;术中使用可透视的下肢托架者20例,记为A1组;未使用托架者9例,为对照组,记为A2组。同时选择胫骨髓内钉固定病例67例,平均年龄33.7岁;术中使用可透视的下肢托架者49例,记为B1组;未使用托架者18例,为对照组,记为B2组。分别记录手术时长、手术方式、骨折愈合时间3项指标。数据使用SPSS16.0软件处理,进行t检验、χ2检验比较。结果:根据股骨倒打髓内钉及胫骨髓内钉插入主钉时膝关节屈曲的角度设计制作的铝制托架为三角形,内角分别为50°、60°、70°。将该下肢托架应用于下肢骨折的手术中并与未使用托架的病例进行比较:A1组手术时间为(73.7±16.8)min,较A2组明显缩短;A1组闭合复位成功率为75.0%,明显高于A2组;A1组术后至临床骨愈合的时间为(15.7±4.2)周,较A2组明显缩短。B1组手术时间为(64.2±14.8)min,明显短于B2组;B1组闭合复位成功率为91.8%,显著高于B2组;B1组临床骨愈合的时间为(14.1±2.8)周,短于B2组,且差异有统计学意义。结论:根据术中膝关节最佳屈曲角度设计的可透视下肢托架,可使膝关节屈曲至最适角度,降低了手术操作难度,加快了手术进程;托架材料可透X线,便于术中透视观察,提高了闭合复位的成功率;同时还减少了医生手术中的射线暴露、保护了术者,是下肢髓内钉手术中的良好辅助工具。Objective： To investigate the design and the application of lower limb radiolucent bracket for lower limbs＇ internal fixation by intramedullary nail. Methods： The femoral retrograde intramedullary nail （9 cases） and tibial internal fixation by intramedullary nail （22 cases） were performed respectively in 31 cases of lower limb＇s fractures （ average age 37.6 years old）. And the knee flexion angles after insertion of the main nail were measured by fluoroscopy during operation. The design and manufacture of lower limb radiolucent bracket were based on the optimal knee flexion angles after insertion of the guide pin. A total of 29 cases of femoral retrograde intramedullary nail （ average age 39.4 years old） were selected for the assessment of lower limb radiolucent bracket. Twenty cases applied the lower limb radiolucent bracket （ group A1 ） and nine cases did not use the lower limb radiolucent bracket were referred as control （ group A2）. There were 67 cases of tibial internal fixation by intramedullary nail with an average age of 33.7 years old. Forty- nine cases of them used the lower limb radiolucent bracket （ group B1 ） and 18 cases of them did not use the lower limb radiolucent bracket （group B2 ）. The operation time, operation method and bone healing time were thoroughly recorded. Independent t-test and Chi-square test were selected for data analysis by SPSS 16.0 software. Results： The design and manufacture of the aluminum-made bracket were based on the knee flexion angles after insertion of the main nail during the process of femoral retrograde intramedullary nail and tibial internal fixation by intramedullary nail. The bracket was triangle in shape, with the angle 50°, 60° and 70°. The bracket was applied to lower limbs＇ fracture operation and compared with cases not using it. The operation time of group A1 was （73.7 ± 16. 8） min, significantly shorter than that of group A2. The success rate of closed reduction for group A1 was 75.0%, significantly higher

关 键 词：可透视 下肢托架 髓内钉 内固定 胫骨骨折 股骨骨折 

分 类 号：R683.4[医药卫生—骨科学]