红外导航锁定型胫骨髓内钉治疗复杂性胫腓骨骨折  

Intramedullary nailing of complex tibial and fibular fractures by infrared tracking navigation positioning

作　　者：朱劲松[1] 谢加兵[1] 王强[1] 宣华兵[1] 汪正宇[1] 杨民[1] 周茂生[1] ZHU Jingsong XIE Jiabing WANG Qiang XUAN Huabing WANG Zhengyu YANG Min ZHOU Maosheng(Department of Trama Orthopaedics ,The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院创伤骨科,安徽芜湖241001

出　　处：《皖南医学院学报》2016年第4期358-361,共4页Journal of Wannan Medical College

基　　金：安徽省卫生厅医学科研课题(09C234;2010C065);皖南医学院重点培育基金项目(WK2014ZF14)

摘　　要：目的：探讨闭合复位经皮红外导航锁定型胫骨髓内钉治疗胫腓骨复杂性骨折的临床效果。方法：回顾性分析2013年6月~2014年12月期间31例胫腓骨多段骨折病例,男19例,女12例;平均年龄（47.3±7.8）岁。AO分型B型16例,C型15例;开放性骨折6例,闭合性骨折25例。均采用闭合复位经皮红外导航锁定型胫骨髓内钉固定,并对术中透视、出血量、骨折愈合和膝踝关节功能等进行评价。结果：31例患者平均手术时间（48.27±8.25）min,平均术中出血（68.63±7.23）m L,平均随访（19.1±4.3）个月。术中远端锁孔一次性锁定率为96.77%;均进行胫骨干角、胫骨上角、胫骨踝穴角和胫骨踝穴角测量,并进行术前、术后角度的比较,其术后角度基本在正常范围之内,经配对t检验,术后较术前明显改善,差异具有统计学意义（P〈0.01）。术后6个月对膝踝关节进行Johner-Wruhs疗效评定,其中优22例,良7例,可2例,优良率为93.54%。结论：红外导航锁定型胫骨髓内钉治疗胫腓骨复杂性骨折临床疗效良好,手术操作简单、创伤小、时间短、远端锁钉锁定准确且术中透视少,是一种值得推广的临床内固定方法。Objective： To assess the clinical curative effect of intramedullary nailing of complex tibial and fibular fractures with percutaneous infrared tracking navigation positioning.Methods： Clinical data were retrospectively examined in 31 cases with complex bibial and fibular fractures treated in our department between June 2013 and December 2014.Nineteen were men and 12 women,with an average age of（ 47.3±7.8） years.By AO classification,16 cases were in type B,and 15 in type C.Six cases were open fractures and 25 closed fractures.All patients received intramedullary nailing device via percutaneous infrared tracking navigation positioning,and evaluation regarding the intra-operative fluoroscopy,volume of total blood loss in operation,fracture healing and recovery of the knee and ankle joint function after surgery.Results： Follow-up in the total 31 cases was（ 9.1 ±4.3） months.Average operative time was（ 48.27±8.25） min,and intraoperative blood loss was（ 68. 63 ± 7. 23） m L. Successful intramedullary nailing of distal placement at one attempt was99.77%.Measurement and comparison of the tibial angle as well as shaft angle of tibia and ankle before and after operation indicated that the angles were in normal range.Paired t-test showed that all patients were significantly improved after surgery（ P0.01）.Assessment of the knee and ankle joint function6 month after surgery by Johner-Wruhs scoring indicated excellent curative effect in 22 cases,good in 7 and fair in 2. The excellent rate was 93. 54%.Conclusion： Itramedullary nailing of the complex tibial and fibular fractures with percutaneous infrared tracking navigation is worthy of wider clinical recommendation because of its better curative effect,easy performance,minimal invasion,shortened operative time,accurate positioning and lower X-ray exposure during the surgery.

关 键 词：胫腓骨骨折 锁定型胫骨髓内钉 红外导航定位系统 

分 类 号：R687.3[医药卫生—骨科学]