中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2015年
8期
714-718
,共5页
付备刚%王秀会%夏胜利%王明辉
付備剛%王秀會%夏勝利%王明輝
부비강%왕수회%하성리%왕명휘
股骨骨折%骨折固定术,髓内%骨钉%外科器械
股骨骨摺%骨摺固定術,髓內%骨釘%外科器械
고골골절%골절고정술,수내%골정%외과기계
Femoral fractures%Fracture fixation,intramedullary%Bone nails%Surgical instruments
目的 自行设计并研制股骨干骨折闭合复位的辅助器械,探讨其临床应用效果.方法 2012年1月-2014年6月,在普通可透视床上行闭合复位顺行交锁髓内钉内固定术,术中使用自行研制的新型股骨撑开复位器行辅助闭合撑开复位治疗股骨干骨折患者18例,其中男14例,女4例;年龄21~48岁,平均33.6岁.骨折按AO分型:32A2型8例,32A3型5例,32B1型3例,32B2型2例.受伤至手术时间3~10d,平均5.5d.评估手术时间、术中出血量、导针进入骨折远端的穿针次数、需小切口辅助复位的患者例数、骨折愈合时间,根据美国纽约特种外科医院(HSS)评分标准评定膝关节功能,观察手术并发症. 结果 手术时间85 ~130 min,平均96 min.术中出血量120 ~180 ml,平均150 ml.术中C形臂X线机透视时间20 ~40 s,平均25 s.导针进入骨折远端的穿针次数1~3次,平均1.5次.需小切口辅助复位的患者1例.14例术后股骨外旋畸形为2°~6°,平均3.6°;4例无旋转畸形.18例患者获6~ 20个月(平均12.8个月)随访.骨折全部愈合,愈合时间4.5 ~8.5个月,平均5.5个月.无医源性骨折、感染、神经血管损伤、断钉及其他并发症发生.末次随访时HSS膝关节功能评分:优12例,良4例,可2例,优良率为89%.结论 新型股骨干骨折撑开复位器操作方便,对常规闭合复位困难的股骨干骨折能很好地辅助撑开复位,并能有效辅助髓内钉进针,临床应用价值较高.
目的 自行設計併研製股骨榦骨摺閉閤複位的輔助器械,探討其臨床應用效果.方法 2012年1月-2014年6月,在普通可透視床上行閉閤複位順行交鎖髓內釘內固定術,術中使用自行研製的新型股骨撐開複位器行輔助閉閤撐開複位治療股骨榦骨摺患者18例,其中男14例,女4例;年齡21~48歲,平均33.6歲.骨摺按AO分型:32A2型8例,32A3型5例,32B1型3例,32B2型2例.受傷至手術時間3~10d,平均5.5d.評估手術時間、術中齣血量、導針進入骨摺遠耑的穿針次數、需小切口輔助複位的患者例數、骨摺愈閤時間,根據美國紐約特種外科醫院(HSS)評分標準評定膝關節功能,觀察手術併髮癥. 結果 手術時間85 ~130 min,平均96 min.術中齣血量120 ~180 ml,平均150 ml.術中C形臂X線機透視時間20 ~40 s,平均25 s.導針進入骨摺遠耑的穿針次數1~3次,平均1.5次.需小切口輔助複位的患者1例.14例術後股骨外鏇畸形為2°~6°,平均3.6°;4例無鏇轉畸形.18例患者穫6~ 20箇月(平均12.8箇月)隨訪.骨摺全部愈閤,愈閤時間4.5 ~8.5箇月,平均5.5箇月.無醫源性骨摺、感染、神經血管損傷、斷釘及其他併髮癥髮生.末次隨訪時HSS膝關節功能評分:優12例,良4例,可2例,優良率為89%.結論 新型股骨榦骨摺撐開複位器操作方便,對常規閉閤複位睏難的股骨榦骨摺能很好地輔助撐開複位,併能有效輔助髓內釘進針,臨床應用價值較高.
목적 자행설계병연제고골간골절폐합복위적보조기계,탐토기림상응용효과.방법 2012년1월-2014년6월,재보통가투시상상행폐합복위순행교쇄수내정내고정술,술중사용자행연제적신형고골탱개복위기행보조폐합탱개복위치료고골간골절환자18례,기중남14례,녀4례;년령21~48세,평균33.6세.골절안AO분형:32A2형8례,32A3형5례,32B1형3례,32B2형2례.수상지수술시간3~10d,평균5.5d.평고수술시간、술중출혈량、도침진입골절원단적천침차수、수소절구보조복위적환자례수、골절유합시간,근거미국뉴약특충외과의원(HSS)평분표준평정슬관절공능,관찰수술병발증. 결과 수술시간85 ~130 min,평균96 min.술중출혈량120 ~180 ml,평균150 ml.술중C형비X선궤투시시간20 ~40 s,평균25 s.도침진입골절원단적천침차수1~3차,평균1.5차.수소절구보조복위적환자1례.14례술후고골외선기형위2°~6°,평균3.6°;4례무선전기형.18례환자획6~ 20개월(평균12.8개월)수방.골절전부유합,유합시간4.5 ~8.5개월,평균5.5개월.무의원성골절、감염、신경혈관손상、단정급기타병발증발생.말차수방시HSS슬관절공능평분:우12례,량4례,가2례,우량솔위89%.결론 신형고골간골절탱개복위기조작방편,대상규폐합복위곤난적고골간골절능흔호지보조탱개복위,병능유효보조수내정진침,림상응용개치교고.
Objective To evaluate a new self-designed device to assist closed reduction of femoral shaft fracture.Methods From January 2012 to June 2014,18 cases of femoral shaft fracture received closed reduction and internal fixation with anterograde intramedullary nails on a popular fluoroscopic orthopedic table.The new self-designed distraction reduction device was used during the operation.The patients contained 14 males and 4 females,aged from 21 to 48 years (mean,33.6 years).Fracture AO classification was type 32A2 in 8 cases,32A3 in 5 cases,32B1 in 3 cases and 32B2 in 2 cases.Mean pre-operation time was 5.5 days (range,3-10 days).Results Operation time ranged from 85 to 130 minutes (mean,96 minutes).Intraoperative bleeding ranged from 120 to 180 ml (mean,150 ml).X-ray fluoroscopy time ranged from 20 to 40 seconds (mean,25 seconds).Frequency of nailing into the distal fracture end was 1 to 3 times (mean,1.5 times).One case had additional small incision for open reduction.Fourteen cases experienced external rotational deformity of the femur from 2° to 6° (mean,3.6°) after surgery,and four cases were free of rotational deformity.All patients were followed up for 6 to 20 months (mean,12.8 months).All patients had fracture healing in a period of 4.5 to 8.5 months (mean,5.5 months).No iatrogenic fracture,infections,nail breakage or other complications occurred.At the final follow-up,knee score according to the system of hospital for special surgery (HSS) was found to be excellent in 12 cases,good in 4,and fair in 2,giving an excellent-togood rate of 89%.Conclusion The new self-designed distraction device is an easy-to-operate instrument that is useful in assisting distraction and reduction of the femoral shaft fracture diffictlt to be fixed with routine methods as well as intramedullary nailing just on a popular fluoroscopic orthopedic table.