应用镜下撑开手柄建立工作空间辅助关节镜下四肢骨内固定物取出术的临床效果观察  

Effect of distracter on making working space under arthroscopy in internal fixator removing surgery of the extremities

作　　者：赵东旭 王铁英 霍鑫 ZHAO Dongxu;WANG Tieying;HUO Xin(Department of Orthopaedics,The Second Hospital of Chifeng City,Chifeng 024000,Inner Mongolia,China)

机构地区：[1]赤峰市第二医院骨一科,内蒙古赤峰024000

出　　处：《中华骨与关节外科杂志》2020年第12期1001-1006,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:应用关节镜实施四肢骨折愈合后内固定物微创取出术中如何获得镜下开阔的工作空间、清晰的手术视野是限制这一技术临床应用的主要问题。目的:观察应用镜下撑开手柄建立工作空间辅助关节镜实施四肢骨内固定物取出术的临床应用效果。方法:选取2016年3月至2019年11月因四肢骨骨折术后骨愈合内固定物存留就诊我院的患者36例,包含锁骨、尺骨、肩胛骨、股骨、胫骨、腓骨、跟骨内固定物。以自身对照、对比观察的方法,分别采用传统方法和应用镜下撑开手柄两种方式建立镜下工作空间辅助关节镜实施骨内固定物取出操作,以"内固定物显露、镜下视野、操作空间、手术操作难易程度"作为评价指标综合评分,对比上述两种方式建立的镜下工作空间情况及临床应用效果。结果:传统方法建立的镜下工作空间临床应用效果:优2例,良18例,差16例。评定为"差"的主要原因集中在"镜下工作空间狭小、组织遮挡镜下视野受限、内固定物显露不佳"三方面。镜下撑开手柄建立的镜下工作空间临床应用效果:优33例,良3例,差0例。相比传统方法应用镜下撑开手柄建立的镜下工作空间内固定物显露清晰、镜下视野开阔、操作空间充足、镜下手术更易实施。结论:在实施关节镜下四肢骨内固定物取出术中,应用镜下撑开手柄是一种很好的建立镜下工作空间的方法。Background:How to obtain a wide working space and definitive surgical fields is a main problem to limit the wide application of removing internal implants with minimal invasive arthroscopy surgery.Objective:To observe the clinical application of a homemade distracter in making a working space to assist arthroscopy in minimally invasive internal fixation plates and screws removal in extremities.Methods:A total of 36 patients with bone fractures healed but internal fixations remaining treated in our hospital from March 2016 to November 2019 were selected.Residual internal fixators were removed from the clavicle,ulna,scapula,femur,tibia,fibula and calcaneus.Based on the methods of self-control and contrast observation,the traditional method and the homemade distracter were used and compared to make a working space to assist arthroscopy in internal fixation removal in extremities.Scores such as exposed degree of internal fixture,wideness of arthroscopic field of view,operable space and difficulty of the operation were evaluated comprehensively to compare the clinical application effects of the above two methods.Results:The clinical application effect of the working space establishment of the traditional method was excellent 2,good 18,and poor 16.The main reasons for the evaluation as"poor"focused on three aspects:small operating space,limited field of vision occluded by tissue,and poor internal fixation exposure.The clinical application effect of the working space establishment of homemade distracter was excellent 33,good 3,and 0 poor.Compared with the traditional method,homemade distracter was better for more visible internal fixtors,wider field of view under arthroscopy,more space for operation and making surgery easier to complete.Conclusions:The homemade distracter is a good way to build a working space in the operation to remove internal fixator of extremities under arthroscopy.

关 键 词：关节镜 内固定物取出 工作空间 

分 类 号：R687.3[医药卫生—骨科学]