自制克氏针连接杆联合常规髓内钉取出器在难取髓内内置物中的应用  

Application of our self-made Kirschner wire connecting rod in difficult extraction of intramedullary implants

作　　者：王武[1] 李发灿 曾敏[3] 谢杰 雷鹏飞 胡懿郃 樊晓磊 Wang Wu;Li Facan;Zeng Min;Xie Jie;Lei Pengfei;Hu Yihe;Fan Xiaolei(Department of Orthopedics,The Fifth Hospital Affiliated to Xinjiang Medical University,Urumqi 830011,China;Department of Orthopedics,The First Hospital Affiliated to Kunming Medical University,Kunming 650000,China;Department of Orthopedics,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Orthopaedics,The First Hospital Affiliated to Zhejiang University,Hangzhou 315000,China;Department of Orthopedics,Honghui Hospital Affiliated to Medicine College,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]新疆医科大学第五附属医院骨科,乌鲁木齐830011 [2]昆明医科大学第一附属医院骨科,昆明650000 [3]中南大学湘雅医院骨科,长沙410008 [4]浙江大学第一附属医院骨科,杭州315000 [5]西安交通大学附属红会医院骨科,西安710054

出　　处：《中华创伤骨科杂志》2023年第8期684-689,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨自制克氏针连接杆联合常规髓内钉取出器在难取髓内装置取出中的应用情况。方法回顾性分析2012年1月至2017年8月新疆医科大学第五附属医院骨科收治的10例难取髓内装置患者的资料。男7例,女3例;年龄(40.0±9.0)岁。当无相关髓内装置取出器或取出器连杆与髓内装置尾端无法连接时,应用克氏针折弯穿过髓内装置尾端螺钉孔或新钻的孔与普通取出器连杆捆扎固定形成有效连接,然后将其回敲拔出。胫骨髓内钉7例,股骨髓内钉1例,肱骨髓内钉1例,胫骨弹性钉1例。其中髓内钉尾帽"冷焊接"无法取掉者3例,取出器螺纹杆与髓内钉尾端螺纹孔不匹配者4例,无相关取出工具者3例。记录术中髓内装置总取出时间、术中出血量和术后不良反应。结果单纯取出内置物者9例,更换内置物者1例。髓内装置总取出时间为(2.3±0.8)h,范围值为1.0~3.2 h;术中出血量为(159.0±61.0)mL,范围值为80~250 mL。10例患者术后获(14.5±2.2)个月随访,范围值为11~18个月。术后均无感染及内置物取出相关骨折发生。结论应用自制克氏针连接杆联合常规髓内钉取出器可成功取出难取髓内装置,操作简便,勿需更多特殊器械。Objective To report the application of our self-made Kirschner wire connecting rod combined with a conventional intramedullary nail extractor in difficult extraction of intramedullary devices.Methods From January 2012 to August 2017,10 patients with a hard-to-remove intramedullary device were treated at Department of Orthopaedics,The Fifth Hospital Affiliated to Xinjiang Medical University.They were 7 males and 3 females with a mean age of(40.0±9.0)years.In cases where no relevant extractor was available for the intramedullary device or it was impossible to connect the extractor connecting rod to the tail of the intramedullary device,the Kirschner wire was bent and pulled through the screw hole or the hole newly drilled at the tail of the intramedullary device to be tied or fixed with a conventional extractor connecting rod to form an effective connection.Next,our self-made Kirschner wire connecting rod was used to pull out the intramedullary device.In this cohort,7 intramedullary nails in the tibia,1 femoral intramedullary nail,1 humeral intramedullary nail,and 1 tibial elastic nail were removed.The difficult extraction was due to"cold welding"of the tail cap of the intramedullary nail in 3 cases,mismatch between the screw rod of the extractor and the tail screw hole of the intramedullary nail in 4 cases,and unavailability of relevant removal tools in 3 cases.The time for intramedullary device removal,blood loss and postoperative adverse reactions were recorded.Results Of this cohort,9 patients underwent simple removal of the intramedullary device and 1 patient replacement of the intramedullary device.The total time for removal of an intramedullary device was(2.3±0.8)h,ranging from 1.0 to 3.2 h.The amount of blood loss was(159.0±61.0)mL,ranging from 80 to 250 mL.The follow-up was(14.5±2.2)months,ranging from 11 to 18 months.There was no infection or fracture associated with implant removal.Conclusion Application of our self-made Kirschner wire connecting rod in combination with a conventional intramedullary

关 键 词：骨钉 装置取出 血量 髓内内置物 

分 类 号：R687.3[医药卫生—骨科学]