CAJ | 학술논문

目的探讨自行研制的下肢骨折牵引复位器用于下肢长骨骨折微创手术中的骨折复位的安全性和有效性.方法 2007年2月至2009年3月采用闭合或者有限切开复位、经皮钢板螺钉内固定治疗股骨远端及胫骨干骺端骨折34例,依据AO-OTA分类标准,其中股骨远端骨折3例(33-B型2例,33-C型1例),胫骨近端骨折14例(41-A型9例,41-B型3例,41-C型2例),胫骨远端骨折17例(43-A型9例,43-B型5例,43-C型3例,其中2例为Gustilo Ⅰ a);采用闭合复位、带锁髓内钉内固定治疗胫骨干骨折36例(42-A型7例,42-B型21例,42-C型8例,其中4例为Gustilo Ⅰ a).术中均应用自行设计的下肢骨折牵引复位器辅助骨折复位.70例患者平均年龄37.6岁(17～63岁),受伤至手术的平均时间4.7 d(0.7～12.0 d).记录术中骨折复位所需时间、骨折复位所需术中C臂机透视时间.拉线测量髂前上棘至第1、2趾蹼间的直线是否大致经过髌骨中心点,判断患肢术后力线的恢复.术后记录双下肢长度(棘踝线测量)的差值以判断患肢术后长度的恢复.以术后骨折的X线正、侧位片分别测量骨折复位后内外翻、前后向成角角度.结果 70例患者术中骨折复位所需时间12.7 min(7～31 min).骨折复位所需术中X线透视时间1.3 min(0.4～3.0 min).双下肢长度的差值为(6.5±1.1)mm,双下肢力线差值为(7.0±1.8)mm.患肢术后长度及力线恢复满意.骨折复位后X线片测量,内外翻角度(2.75±0.16)°;前后向成角角度(5.13±0.51)°.结论下肢骨折牵引复位器在下肢长骨骨折微创手术中,不但能辅助医生获得满意的骨折复位,而且能在内固定物置入过程中稳定地维持骨折复位,操作简单、使用方便.
목적 탐토자행연제적하지골절견인복위기용우하지장골골절미창수술중적골절복위적안전성화유효성.방법 2007년2월지2009년3월채용폐합혹자유한절개복위、경피강판라정내고정치료고골원단급경골간후단골절34례,의거AO-OTA분류표준,기중고골원단골절3례(33-B형2례,33-C형1례),경골근단골절14례(41-A형9례,41-B형3례,41-C형2례),경골원단골절17례(43-A형9례,43-B형5례,43-C형3례,기중2례위Gustilo Ⅰ a);채용폐합복위、대쇄수내정내고정치료경골간골절36례(42-A형7례,42-B형21례,42-C형8례,기중4례위Gustilo Ⅰ a).술중균응용자행설계적하지골절견인복위기보조골절복위.70례환자평균년령37.6세(17～63세),수상지수술적평균시간4.7 d(0.7～12.0 d).기록술중골절복위소수시간、골절복위소수술중C비궤투시시간.랍선측량가전상극지제1、2지복간적직선시부대치경과빈골중심점,판단환지술후력선적회복.술후기록쌍하지장도(극과선측량)적차치이판단환지술후장도적회복.이술후골절적X선정、측위편분별측량골절복위후내외번、전후향성각각도.결과 70례환자술중골절복위소수시간12.7 min(7～31 min).골절복위소수술중X선투시시간1.3 min(0.4～3.0 min).쌍하지장도적차치위(6.5±1.1)mm,쌍하지력선차치위(7.0±1.8)mm.환지술후장도급력선회복만의.골절복위후X선편측량,내외번각도(2.75±0.16)°;전후향성각각도(5.13±0.51)°.결론 하지골절견인복위기재하지장골골절미창수술중,불단능보조의생획득만의적골절복위,이차능재내고정물치입과정중은정지유지골절복위,조작간단、사용방편.
Objective To develop a traction reductor for the reduction of lower limb fractures during the minimally invasive surgery and explore its safety and efficacy. Methods From February 2007 to March 2009, closed or limited open reduction plus percutaneous plate and screw internal-fixation were conducted in 34 patients with fracture of distal femur and tibia metaphysic, among which there were 3 distal femoral fractures (2 33-B, 1 33-C), 14 proximal tibial fractures (9 41-A, 3 41-B, 2 41-C) and 17 distal tibial fractures (9 43-A, 5 43-B, 3 43-C, 2 Gustilo Ⅰ a), according to the Association for Osteosynthesis Orthopaedic Trauma Association (AO-OTA) classification. Besides, closed reduction plus interlocking intramedullary nailing on tibial shaft fracture were applied in 36 patients (7 42-A, 21 42-B, 8 42-C,2 Gustilo Ⅰ a). All the 70 patients, with an average age of 37. 6 years ( range: 17 to 63 years) and average time before surgery of 4. 7 d (range: 0. 7 to 12. 0 d) , underwent reduction by self-designed traction reductor for lower limb fracture in the surgery. The reduction duration andx C-arm fluoroscopy time were recorded.Recovery of the force line of affected limbs after surgery was determined by whether the line from anterior superior iliac spine to the interdigit between the first and second toe-web passed the patella center. And the distance from bilateral anterior superior iliac spine to medial malleolus tip as well as the difference between lower limbs were recorded to determine the recovery of length after surgery. Meanwhile, the varus-valgus and anteroposterior angulations after reduction were measured by AP and lateral X-ray. Results The reduction duration was 12. 7 min (range: 7 to 31 min); X-ray fluoroscopy time, 1.3 min (range: 0. 4 to 3.0 min);length difference between both lower limbs ( 6. 5 ± 1.1 ) mm; and axial alignment difference ( 7.0 ± 1. 8 )mm. The X-ray result showed that varus-valgus angle was (2.75 ±0. 16)°; and anteropsterior angulation (5. 13 ± 0. 51 ) °. Conclusion The traction reductor for lower limb fracture could achieve satisfying fracture reduction in the minimally invasive surgery of distal femur, tibia metaphysic and tibial shaft fracture.