斯氏针辅助技术在股骨多段(处)骨折髓内钉内固定术中的应用  

Application of Steiner’s needle assisted technique in the fixation of intramedullary nailing of multisegmental fracture of femur

作　　者：欧阳国新 许景红 汤志辉 毛成鹏 李铭 OUYANG Guo-xin;XU Jing-hong;TANG Zhi-hui;MAO Cheng-peng;LI Ming(The First Division Hospital of Xinjiang Corps,Xinjiang,Akesu,843000,China)

机构地区：[1]新疆兵团第一师医院,新疆阿克苏843000

出　　处：《新疆医学》2020年第9期917-920,共4页Xinjiang Medical Journal

摘　　要：目的探讨采用斯氏针辅助技术在股骨多段(处)骨折髓内钉内固定术中的应用价值和安全性。方法2013年2月至2017年3月,采用斯氏针辅助技术、髓内钉内固定治疗股骨多段(处)骨折23例,男17例、女6例:年龄21~64岁,平均39岁;按股骨骨折部位分类,股骨颈基底骨折合并股骨中段骨折5例、股骨干骨折合并股骨髁上骨折3例、股骨干两处骨折11例:股骨干3处骨折4例。术前等待时间4~10 d,平均6 d。结果21例闭合复位成功;2例因骨折块移位明显,经皮斯氏针撬拨复位。手术时间60~120min,平均93min。术中出血量150~250ml,平均180ml。本组患者均获随访,随访时间6~24个月,平均13个月。21例骨折获得临床愈合,愈合时间12~20周,平均13周;1例骨折因骨折块移位导致骨部分不愈合,二期植骨后愈合,1例因骨折断端间隙较大,骨折延迟愈合,6个月时将髓内钉动力化处理后,术后11个月骨折端愈合。末次随访时,参照《常用骨科分类法和功能评定》中股骨干骨折疗效评定标准评价疗效,优18例、良4例、可1例。无切口感染、神经血管损伤、下肢深静脉血栓形成、肺栓塞等并发症。结论髓内钉内固定治疗股骨多段(处)骨折时,术中采用斯氏针辅助技术可有效防止中间骨折段的旋转移位,辅助复位骨折,作为阻挡钉使髓内钉在股骨远端髓腔获得最佳位置,减少复位不良,提高骨折愈合率,有利于患肢功能的恢复,并发症少,值得临床推广应用。Objective To evaluate the value and safety of Steiner’s needle assisted technique in the fixation of intramedullary nailing of multisegmental fracture of femur.Methods From February 2013 to March 2017,23 cases with multisegmental fracture of femur were treated with Steiner’s needle assisted technique in intramedullary nail fixation.Among all cases,male cases were 17 cases,female were 6 cases,and whose ages were from 21 to 64 years old,and average age was 39 years old.All cases were classified according to location of femoral fracture.There were 5 cases with basal fracture of femoral neck combined with mid-femoral fracture,3 cases with Femoral shaft fracture combined with supracondylar fracture of femur,11 cases with fractures of femoral shaft in two places,4 cases with fractures of femoral shaft in three places.Pre-operative waiting time was about 4-10 days,with an average of 6 days.Results 21 cases were cured with closed reduction method successfully.In 2 cases,because of the obvious displacement of the fracture block,Steiner’s needle was used percutaneously to pry and reset.The operation time was 60-120 min,with an average of 93 min.Intraoperative blood loss was 150-250 ml,with an average of 180 ml.All patients in this group were followed up for 6 to 24 months,and average time was 13 months.21 cases of fractures were healed with healing time of 12 to 20 weeks,average time was 13 weeks;1 case of fracture was partially nonunion due to the displacement of the fracture mass,but healed after the second-stage bone graft,One case had a larger gap between the broken ends of the fracture,the fracture delayed union,6 months after intramedullary nailing motorization process,fracture end healing 11 months after operation.At the last follow-up,the efficacy of femoral shaft fractures was evaluated according to the standard of efficacy evaluation about femoral shaft fractures in common orthopedics classification and functional assessment.It turned out 18 cases were excellent,4 cases were good and 1 case were common.Ther

关 键 词：股骨多段(处)骨折 斯氏针 骨折固定术 辅助复位 对抗旋转 

分 类 号：R459.4[医药卫生—治疗学]