自制复位器辅助儿童下肢长骨骨折经皮内固定  

A self-developed reduction device assisted percutaneous internal fixation of lower-extremity long bone fractures in children

作　　者：刘玉昌[1] 韩久卉[1] 王宣[1] 罗军忠[1] 李亚洲[1] 曹进超[1] LIU Yu-chang;HAN Jiu-hui;WANG Xuan;LUO Jun-zhong;LI Ya-zhou;CAO Jin-chao(The Third Hospital,Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院,河北石家庄050051

出　　处：《中国矫形外科杂志》2021年第6期544-547,共4页Orthopedic Journal of China

基　　金：河北省医学科学研究课题计划项目(编号:20190642),专利编号:ZL201821004616.6。

摘　　要：[目的]介绍复位器辅助经皮内固定治疗儿童下肢长管状骨难复性骨折的手术技术与初步临床结果。[方法] 2017年1月~2019年8月,采用复位器辅助经皮内固定治疗儿童下肢长管状骨难复性骨折29例,包括股骨骨折27例,胫骨骨折2例。首先安装复位器,轴向牵引矫正短缩畸形,如残留明显侧方或旋转移位,安装辅助装置,施加径向牵引,达到骨折复位,经皮逆行或顺行置入弹性髓内钉固定。[结果] 29例下肢长管状骨骨折应用复位器闭合复位成功。24例股骨骨折行逆行弹性髓内钉置入,3例股骨骨折行顺行弹性钉置入,2例胫骨骨折行顺行弹性钉置入。手术时间27~56 min,平均(39.31±3.03) min。术中出血量5~29 ml,平均(11.76±4.27) ml。末次随访时根据Flynn评价标准,临床结果优良率为100%。[结论]复位器直接作用于肢体骨骼,符合生物力学,力量持续有效,闭合复位质量高,减少术中X线暴露。[Objective] To introduce the surgical technique and preliminary clinical results of a self-developed reduction device assisted percutaneous internal fixation of lower-extremity long bone fractures in children. [Methods]From January 2017 to August 2019, 29 children with irreducible fractures of the lower-extremity long bones received closed reduction and percutaneous internal fixation with elastic stable intramedullary nails under assistance by using this self-developed reduction device. After the reduction device was installed, axial traction was firstly applied to correct the shortening deformity. If obvious residual lateral or rotational displacement remained after axial traction, transvers traction was conducted by auxiliary devices attached on the reduction device to achieve proper closed reduction of the fractures. Finally, the fractures were fixed with retrograde or anterograde elastic stable intramedullary nails percutaneously. [Results]All the 29 children got successful closed reduction and internal fixation of lower-extremity long bone fractures with this reduction device, including 24 cases of femoral fractures fixed with retrograde elastic nail, 3 cases of femoral fractures with anterograde elastic nail, and 2 cases of tibia fractures with anterograde nail. The operation lasted for 27 to 56 minutes with an average of(39.31±3.03) minutes, associated with intraoperative blood loss of 5~29 ml with an average of(11.76±4.27) ml. According to Flynn’s evaluation criteria at the last follow-up, the excellent and good rate of the clinical outcomes was 100%. [Conclusion]This novel reduction device, applying force directly on the bones,meet the principle of biomechanics, and has advantages of continuous and effective traction strength to achieve high quality closed reduction of fracture, whereas reducing X-ray exposure.

关 键 词：股骨骨折 胫骨骨折 弹性髓内钉 儿童 复位器 

分 类 号：R683.42[医药卫生—骨科学]