新型自制髓内钉置入髓内桥接固定锁骨中段骨折

A novel self-made intramedullary nail fixation of the middle segment for clavicle fractures

背景:符合微创治疗原则的髓内固定锁骨骨折的方法成为广大学者研究的重点,目前较多采用克氏针髓内穿针治疗锁骨中段骨折,但效果均不理想。目的:测量分析成人锁骨解剖结构相关数据,研制一种新型成人锁骨中段骨折内固定的髓内钉,并探讨其优缺点。方法:通过对40根成人锁骨以及5具新鲜尸体标本相关数据测量,设计出新型锁骨髓内钉。采用双螺纹克氏针髓内穿针,含内螺纹自攻自钻空心螺钉(内六角)固定双螺纹克氏针两端以达到固定锁骨中段骨折的要求。结果与结论:锁骨全长为(14.85±1.22)cm,锁骨中段长为(5.89±0.61)cm,外侧段与中段夹角,中段与内侧段夹角均为125°左右,锁骨中段最窄处直径为(1.02±0.15)cm,锁骨中段最窄处髓腔内径为(0.53±0.16)cm,从锁骨中段骨折处逆行髓内穿针,复位骨折后顺行穿出骨皮质,固定骨折后剪断多余克氏针,于两端拧入含内螺纹自攻自钻空心螺钉,固定稳定可靠。这种新型自制髓内钉是利用含内螺纹自攻自钻空心螺钉与骨折两端形成稳定模块,通过双螺纹克氏针髓内桥接,具有支撑和加压相互作用,符合微创原则,直视下复位满意,固定可靠,但相关生物力学数据有待进一步探讨。

BACKGROUND：Intramedullary nails for fixation of clavicle fractures have become a focus.However,the effect of Kirschner wire intramedullary pinning is not satisfactory.OBJECTIVE：To measure and analyze adult clavicle anatomy related data to develop a new type of adult clavicle fracture fixation in the middle of intramedullary nails,and to explore the advantages and disadvantages.METHODS：According to measurement data of 40 adult clavicle and 5 fresh cadaver specimens,a new type of clavicular intramedullary nail was designed,which uses double-threaded Kirschner wire intramedullary pinning,containing hollow thread self-tapping self-drilling screws（Hexagon） fixed pairs of threaded Kirschner wire at both ends in order to achieve a fixed mid-clavicular fractures requirements.RESULTS AND CONCLUSION：Clavicle length was（14.85±1.22） cm,middle clavicle length（5.89±0.61） cm,the outer segment and the middle angle,as well as the angle between the middle and the medial segment were 125°;the narrowest diameter of middle segment of the clavicle was（1.02±0.15） cm,the inner diameter of the narrowest at the middle clavicular marrow cavity was（0.53±0.16） cm.The intramedullary pinning retrograded from the mid-clavicle fracture and anterograded cortical bone after fracture reduction;after the fracture was fixed,the redundant Kirschner wire was cut,and hollow thread self-tapping self-drilling screws were threaded at both ends with stable and reliable fixation.This new self-made intramedullary nail forms a stable module using a thread containing hollow self-tapping self-drilling screws and fracture at both ends,bridged by intramedullary Kirschner wire,with a supporting and pressing interaction.It is in accordance with the principles of minimally invasion,with satisfactory reduction and reliable fixation.However,related biomechanical data require further investigation.