CAJ | 학술논문

背景：AO组织推荐的下胫腓联合横向螺钉是目前治疗下胫腓联合分离的常用方法，然而该手术方法对术者经验要求较高和术中多次X线透视下完成，初学者需要经历较长的学习曲线。术中减少X线暴露、提高置钉准确和安全性、缩短初学者的学习曲线仍是临床医生所关切的问题。 　　目的：自行设计研制一种点对点导向器，介绍其在下胫腓联合分离横向螺钉准确导向置钉的初步临床应用。 　　方法：选择2011年7月至2012年11月下胫腓联合分离患者7例，以AO内固定原则为基础对踝关节及腓骨骨折解剖复位固定，下胫腓联合分离复位后利用自行研制的点对点导向器进行下胫腓联合横向螺钉导向置钉。 　　结果：本组7例患者术后全部获得随访，随访时间6~15个月，平均（11.2±2.4）个月，患者踝关节功能恢复良好，按Baird-Jackson评分标准进行功能评价：优5例，良2例，可、差0例，优良率100%。 　　结论：点对点导向器操作简便，可准确导向置钉，适用于下胫腓联合分离的固定。
배경：AO조직추천적하경비연합횡향라정시목전치료하경비연합분리적상용방법，연이해수술방법대술자경험요구교고화술중다차X선투시하완성，초학자수요경력교장적학습곡선。술중감소X선폭로、제고치정준학화안전성、축단초학자적학습곡선잉시림상의생소관절적문제。 　　목적：자행설계연제일충점대점도향기，개소기재하경비연합분리횡향라정준학도향치정적초보림상응용。 　　방법：선택2011년7월지2012년11월하경비연합분리환자7례，이AO내고정원칙위기출대과관절급비골골절해부복위고정，하경비연합분리복위후이용자행연제적점대점도향기진행하경비연합횡향라정도향치정。 　　결과：본조7례환자술후전부획득수방，수방시간6~15개월，평균（11.2±2.4）개월，환자과관절공능회복량호，안Baird-Jackson평분표준진행공능평개：우5례，량2례，가、차0례，우량솔100%。 　　결론：점대점도향기조작간편，가준학도향치정，괄용우하경비연합분리적고정。
Background: Transverse tibiofibular syndesmosis screw is recommended for distal tibiofibular diastasis by AO Organiza-tion. However,this surgical technique requires a experienced surgeon and repeated X-ray exposure to finish this procedure, and the learning curve is relatively long for the beginners. Reduce the X-ray exposure times,effectively improve the the syn-desmosis screw's placement accuracy and safety,and shortening the learning curve for the beginners are still the concerns of clinicians. Objective:To design a point to point drilling guide and introduce its preliminary clinical application in accurately syndesmo-sis screw placement guiding in distal tibiofibular diastasis. Methods:Seven patients with distal tibiofibular diastasis were chosen. Medial malleolus and fibula fractures were anatomi-cal reduction and internal fixation according to the AO principle. After the distal tibiofibular diastasis reduction,a point to point guiding apparatus was used to accurately place the syndesmosis screw. Results:All seven patients were followed-up post operation for 6 to 15 (11.2±2.4) months, with good ankle functional recov-ery. According to Baird-Jackson ankle function scoring criteria:excellent (5 patients), good (5 patients), fair or poor (no pa-tient). The excellent and good rate was 100%. The preliminary results showed the point to point drilling guide can accurate-ly guide the syndesmosis screw placement. Conclusions:This point to point drilling guide was easy to operate,accurate syndesmosis screw placement guiding in distal tibiofibular diastasis,worth widely promoted in clinical practice.