导航下控制股骨干骨折复位髓内钉固定术的初步临床研究

Navigated reduction and intramedullary nailing of femoral shaft fracture： a preliminary clinical study

目的介绍计算机导航下，根据健侧股骨控制股骨干骨折复位髓内钉固定术这一新技术并探讨初步临床结果。方法应用新的计算机导航模式，根据健侧股骨前倾角控制股骨骨折旋转并进行复位固定。首先应用非侵入性定位标志进行健侧注册，获取影像后导航系统自动计算股骨前倾角。股骨骨折固定微创定位标记系统后获取影像资料进行注册。计算机导航下根据健侧数据进行骨折闭合复位髓内钉固定术。术后双侧肢体同时进行CT扫描对比旋转情况，并与术中导航系统显示结果对比。结果14例股骨骨折应用上述方法成功进行复位固定，无术中及术后并发症发生。术后CT显示股骨旋转与术中导航系统显示结果一致，旋转与健侧相差均在3°以内。结论计算机导航下运用健侧股骨控制骨折复位固定能有效控制股骨旋转，减少术后股骨旋转并发症，是一有效的新技术。

Objective To introduce a new technique of navigated femoral nailing using noninvasive registration of the contralateral femur to control reduction and intramedullary nailing of femoral shaft fracture and discuss preliminary clinical results. Methods A new navigation module was employed to control femoral fracture rotation and fixate femoral fracture based on anteversion of the contralateral femur. In order to measure the femoral anteversion of the healthy femur intraoperatively, a non-invasive registration technique was used. After minimal invasive reference arrays were fixed on the fracture side, images of the fracture side were mandatory for femoral anteversion measurements. Closed reduction and nailing was performed under computer navigation according to data of the eontralteral side of the femur. Postoperative CT scanning on bilateral femur was done to observe specific anteversion and compare with intraoperative results of navigation system. Results A total of 14 patients with femoral fractures obtained successful fixation and reduction, with no intraoperative or postoperative complications. Postoperative CT scans were accordant with the intraoperative navigated measurements, with anteversion deviation within 3° between both sides. Conclusions Navigated femoral nailing using nouinvasive registration of the eontralateral femur to control fracture fixation and reduction can help control anteversion measurements of the fracture site and reduce the incidence of femoral malrotation after closed reduction and intramedullary nailing.