距下关节镜专用牵引器的研制和临床应用报告  

Invention of a distractor specialized for subtalar arthroscopy and its clinical application

作　　者：王晓君[1] 陈鹏[2] 蒋逸秋[3] 桂鉴超[3] 杨晓斐[3] 李杨[3] 石晶[3] 

机构地区：[1]江阴市人民医院血管外科,江苏江阴214400 [2]盐城市第三人民医院骨科,江苏盐城224000 [3]南京医科大学附属南京医院(南京市第一医院)关节外科,南京210006

出　　处：《第三军医大学学报》2015年第3期215-219,共5页Journal of Third Military Medical University

基　　金：江苏省医学创新团队与领军人才项目(LJ201106)~~

摘　　要：目的研制距下关节镜专用牵引器,观察其有效性和安全性。方法距下关节镜专用牵引器呈矩形设计,为胫距跟平行牵引,牵引力完全与距下关节面垂直来达到最大牵引效果。16具踝关节离断新鲜标本分为2组：A组为传统无创牵引组,B组为距下关节镜专用牵引器牵引组。在相同的牵引力量下比较2组牵开的距离。测量16具标本专用牵引器的克氏针与周围血管神经肌腱结构的距离。从2006年6月至2008年5月,我们共采用距下关节镜专用牵引器治疗12例距下关节疾病,包括距下关节创伤性关节炎8例,距骨软骨损伤2例,跗骨窦综合征2例。随访采用AOFAS踝后足功能评分进行评价。结果当牵引力为5.2、10.3 N水平时,A组和B组的关节间隙牵开距离差异不显著;当增大到17.6、24.4、33.8 N时,B组的牵开距离均显著大于A组（P〈0.05）;当牵引力达到41.8 N水平时,2组的牵开距离均达到最大,但B组的最大牵开间隙（3.3 mm）要远远大于A组（2.2 mm,P〈0.01）。解剖学测量显示牵引器的克氏针与周围血管神经等结构有很好的安全距离。12例患者随访平均26.1（15～35）个月,未见任何手术并发症。最后1次随访时,优4例,良6例,一般2例,优良率达到83.3%。结论距下关节镜专用牵引器能很好地牵开距下关节,方便关节镜下手术操作,且安全性高、可操作性好。Objective To invent a specialized distractor for subtalar arthroscopy and observe its effectiveness and safety in vitro and in clinical practice. Methods Our distractor for subtalar arthroscopy was in a rectangular configuration of parallelism between the tibia-talus bones and the calcaneus. Therefore,the generated distraction force was fully perpendicular to the subtalar articular surface so as to achieve maximal distraction effect. Sixteen fresh human ankle specimens were randomly divided into 2 groups（ n = 8 for each group）,group A receiving traditional non-invasive distraction and group B with our designed distractor. The distraction distance at any identical distraction force was observed in the 2 groups of specimens. The safe distances of the K-wires in the distractor from the surrounding neurovascular and tendinous tissues were measured in all 16 specimens. From June 2006 to May 2008,the specialized distractor was used to treat 12 cases of subtalar diseases,including 8 cases of traumatic arthritis,2 of talar cartilage injuries and 2 of sinus tarsal syndrome. American Orthopaedic Foot and Ankle Society（ AOFAS） ankle-hindfoot scores were used to evaluate the outcome during follow-up. Results No difference was found between the 2 groups of ankle specimens when the distraction force was 5. 2 or 10. 3 N,but when the force was increased to 17. 6,24. 4 and33. 8 N,the distance was significantly greater in group B than group A（ P〈0. 05）. The maximal distraction distance was achieved in both groups when the distraction force was increased to 41. 8 N,but it was still larger in group B than group A（ 3. 3 vs 2. 2 mm,P〈0. 01）. Anatomical measurement indicated that all specimens had enough safe distances between the K wires in the distractor and the surrounding vital tissues. All the 12 patients were followed up for 15 to 35 months（ mean,26. 1 months）. No complication was observed. At the last follow-up,there were 4 patients achieving excellent,6 good and 2 fair outcomes,with an excellent and good

关 键 词：距下关节 关节镜 手术疗效 手术方式 

分 类 号：R681.8[医药卫生—骨科学] R687.1[医药卫生—外科学]