“穿针器技术”徒手植入交锁髓内钉远端锁钉  

A Novel Freehand Technique of the"Needle Threader"for Distal Interlocking Intramedullary Screws Placement

作　　者：罗能 蒋锡昌 许自力 徐勇强 LUO Neng;JIANG Xi-chang;XU Zi-li;XU Yong-qiang(Department of Orthopaedics, the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha 410005, Hunan, China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)骨二科,长沙410005

出　　处：《中国现代手术学杂志》2021年第2期122-126,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的报道一种新的徒手植入交锁髓内钉远端锁钉的方法。方法2016年8月至2019年4月共137例骨干骨折患者行闭合复位髓内钉内固定术,其中股骨骨折54例,胫骨骨折83例,术中均采用“穿针器技术”植入交锁髓内钉远端锁钉。结果本组137例患者均成功应用“穿针器”技术置入髓内钉远端锁钉,置钉过程中无须行正位透视。胫骨骨折患者髓内钉固定的手术时间为53~75 min,平均(65.3±10.7)min;股骨骨折患者髓内钉固定时间为62~84 min,平均(73.9±13.1)min。远端2枚横行锁钉植入时间为5~16 min,平均(11.5±1.8)min。术中累计透视时间为8.3~21.6 s,平均(11.3±2.5)s。本组患者均获随访,随访时间6~12个月,所有患者均未出现远端锁钉断裂、拔出,切口感染以及骨折等。结论“穿针器技术”操作简单,易于重复,无须辅助器械及辐射防护,是一种快速、安全、简单的徒手植入交锁髓内钉远端锁钉的技术。Objective To introduce a novel freehand technique of the“needle threader”for distal interlocking of intramedullary nails.Methods From August 2016 to April 2019,a total of 137 patients were performed closed reduction and internal fixation of interlocking intramedullary screws,including 54 of femoral fractures and 83 of tibia fractures.During the placement of distal locking nail,the freehand technique of"needle threader"was applied.Results All 137 cases placed the distal interlocking of intramedullary nails by freehand technique of“needle threader”successfully without positive position fluoroscopy during the surgery.The mean operative time was(65.3±10.7)minutes(ranged from 53 to 75 minutes)in the tibia shaft fracture cases,and was(73.9±13.1)minutes(ranged from 62 to 84 minutes)in the femoral fracture cases.The average placing time of two transverse interlocking nails were(11.5±1.8)minutes(ranged from 5 to 16 min).The cumulative time of fluoroscopy was 8.3 to 21.6 seconds with an average of(11.3±2.5)seconds during the surgery.All cases were followed up for 6 to 12 months,no one was found complication as broken and extraction of distal locking nail,wound infection and fracture.Conclusion The technique of“needle threader”is a simple,safe and fast freehand method for placing the distal interlocking intramedullary nails with advantages as repeat easily and without auxiliary instrument or radiation protection.

关 键 词：骨折固定术 内 交锁髓内钉 胫骨骨折 股骨骨折 置入 

分 类 号：R681.8[医药卫生—骨科学]