中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2010年
7期
637-641
,共5页
骨钉%装置取出%股骨颈骨折%改锥
骨釘%裝置取齣%股骨頸骨摺%改錐
골정%장치취출%고골경골절%개추
Bone nails%Device removal%Femoral neck fractures%Driver
目的 自行设计并研制一种用于取出空心松质骨螺钉的改锥,通过力学测试及临床应用对其实用性进行探讨.方法 自行设计自导向改锥由导向部分、六角部分、杆部和手柄组成.力学测试试验分5组,A组:窄心螺钉内插入导针(进入50 mm)后套入空心改锥,但改锥六角部分与螺钉不接触;B组:在A组基础卜将空心改锥六角部分插入空心螺钉;C组:将自导向改锥导向部分插入空心钉,但改锥六角部分与螺钉小接触;D组:在C组基础上将改锥六角部分插入空心钉;E组:将普通实心改锥六角部分直接插入空心钉.测试空心改锥、自导向改锥及实心改锥的稳定性.2008年6月至2009年6月共收治26例股骨颈骨折空心钉内固定术后再次入院取钉的患者,随机分为自导向改锥组和普通实心改锥组.比较两组患者的取钉手术时间、出血量及切口长度.结果 排除相对移位的影响后,A、B、C、D、E组的侧方稳定性差异有统计学意义(F=94.639,P=0.000,A组与B组、C组与D组比较差异均有统计学意义(P<0.05),E组与B、D组比较差异均有统计学意义(P<0.05),而B组与D组比较差异尤统计学意义(P>0.05).自导向改锥组中39枚螺钉均顺利取出,手术时间和切口长度较普通实心改锥组少,差异有统计学意义(P<0.05);自导向改锥组平均失血量约5 mL,普通实心改锥组平均失血量约30 mL.结论 自导向空心改锥既有普通实心改锥的强度,又能引导和限制改锥方向,从而避免螺钉溢扣.特别适用于股骨颈骨折空心松质骨螺钉固定后的螺钉取出手术.
目的 自行設計併研製一種用于取齣空心鬆質骨螺釘的改錐,通過力學測試及臨床應用對其實用性進行探討.方法 自行設計自導嚮改錐由導嚮部分、六角部分、桿部和手柄組成.力學測試試驗分5組,A組:窄心螺釘內插入導針(進入50 mm)後套入空心改錐,但改錐六角部分與螺釘不接觸;B組:在A組基礎蔔將空心改錐六角部分插入空心螺釘;C組:將自導嚮改錐導嚮部分插入空心釘,但改錐六角部分與螺釘小接觸;D組:在C組基礎上將改錐六角部分插入空心釘;E組:將普通實心改錐六角部分直接插入空心釘.測試空心改錐、自導嚮改錐及實心改錐的穩定性.2008年6月至2009年6月共收治26例股骨頸骨摺空心釘內固定術後再次入院取釘的患者,隨機分為自導嚮改錐組和普通實心改錐組.比較兩組患者的取釘手術時間、齣血量及切口長度.結果 排除相對移位的影響後,A、B、C、D、E組的側方穩定性差異有統計學意義(F=94.639,P=0.000,A組與B組、C組與D組比較差異均有統計學意義(P<0.05),E組與B、D組比較差異均有統計學意義(P<0.05),而B組與D組比較差異尤統計學意義(P>0.05).自導嚮改錐組中39枚螺釘均順利取齣,手術時間和切口長度較普通實心改錐組少,差異有統計學意義(P<0.05);自導嚮改錐組平均失血量約5 mL,普通實心改錐組平均失血量約30 mL.結論 自導嚮空心改錐既有普通實心改錐的彊度,又能引導和限製改錐方嚮,從而避免螺釘溢釦.特彆適用于股骨頸骨摺空心鬆質骨螺釘固定後的螺釘取齣手術.
목적 자행설계병연제일충용우취출공심송질골라정적개추,통과역학측시급림상응용대기실용성진행탐토.방법 자행설계자도향개추유도향부분、륙각부분、간부화수병조성.역학측시시험분5조,A조:착심라정내삽입도침(진입50 mm)후투입공심개추,단개추륙각부분여라정불접촉;B조:재A조기출복장공심개추륙각부분삽입공심라정;C조:장자도향개추도향부분삽입공심정,단개추륙각부분여라정소접촉;D조:재C조기출상장개추륙각부분삽입공심정;E조:장보통실심개추륙각부분직접삽입공심정.측시공심개추、자도향개추급실심개추적은정성.2008년6월지2009년6월공수치26례고골경골절공심정내고정술후재차입원취정적환자,수궤분위자도향개추조화보통실심개추조.비교량조환자적취정수술시간、출혈량급절구장도.결과 배제상대이위적영향후,A、B、C、D、E조적측방은정성차이유통계학의의(F=94.639,P=0.000,A조여B조、C조여D조비교차이균유통계학의의(P<0.05),E조여B、D조비교차이균유통계학의의(P<0.05),이B조여D조비교차이우통계학의의(P>0.05).자도향개추조중39매라정균순리취출,수술시간화절구장도교보통실심개추조소,차이유통계학의의(P<0.05);자도향개추조평균실혈량약5 mL,보통실심개추조평균실혈량약30 mL.결론 자도향공심개추기유보통실심개추적강도,우능인도화한제개추방향,종이피면라정일구.특별괄용우고골경골절공심송질골라정고정후적라정취출수술.
Objective To present a self-designed self-guided driver for clinical removal of cannulated screws. Methods The diameter of the selfguided rod is 2.8 mm and its length is 50 mm.The hexagonal driver head is 4 mm in height,2 mm in width and 5 mm in length.The other parts are similar to those of a solid driver.We then tested the stabilization of the selfdesigned driver by measuring the lateral load and displacement in 5 different experimental groups.Next we put it into use in the 26 patients who had been treated in our department from July 2008 to July 2009.They had been divided into 2 groups randomly.In the self-guided group,there were 9 males and 4 females,with an average age of 36 years and an interval of 30 months after the first operation.In the solid driver group.there were 7 males and 6 females.with an average age of 43 years and an interval of 21 months after the first operation. Results The mechanical tests revealed that the instrument designed by us was stable and could prevent lateral displacement.In clinic.the 39 screws were removed saccessfully in the self-guide driver group.The mean surgical time and incision in the self-guided driver group were significantly less and smaller than in the solid driver group.Conclnsions The self-guided driver is as stiff as a common solid driver and as stable as a cannulated driver.It can reduce the likelihood of screw invalidation which may make the operation very difficult and timeconsuming.It is a simple,timesaving,and less traumatic instrument,especially fit for removal of cannulated screws of the femoral neck.