股骨颈骨折术中空心加压螺纹钉螺纹部分陷入盆腔成功取出1例报道并文献复习

Intrapelvic Protrusion of Cannulated Lag Screw during Operation of Femoral Neck Fracture： Report of One Case and Literature Review

目的：报道1例股骨颈骨折术中空心加压螺纹钉螺纹部分突入盆腔并成功取出的经验，结合文献复习，对空心加压螺纹钉治疗股骨颈骨折的手术原则、注意事项等内容进行归纳总结，为临床医师提供参考。方法：1例股骨颈骨折术中空心加压螺纹钉螺纹部分突入盆腔，将尖端拐弯呈钩状的不锈钢丝插入空心内六角改锥，然后进入空心加压螺纹钉，通过倒钩状尖端钩住螺纹钉并施加适当的牵引力，不锈钢丝钩状尖端抓住空心加压螺纹钉；再以适当的力量牵拉不锈钢丝，逆时针方向转动空心内六角改锥，将其顺利旋出。结果：通过带倒钩的不锈钢丝辅助牵引、内六角改锥反转退钉，成功取出螺纹部分突人盆腔的空心的加压螺纹钉，患者无并发症，骨折顺利愈合。结论：老年患者因骨质疏松，股骨近端外侧骨皮质较薄弱，拧人空心拉力螺纹钉时钉尾易陷入骨皮质；在拧人空心加压螺纹钉的过程中，应在x线透视监视下进行，在最上方的空心加压螺纹钉尾端应安装垫片。

Objective：To report a technique to retrieve intrapelvic protrusion of cannulated lag screw during operation of femoral neck fracture with related reviews for clinical reference. Methods：During operation of femoral neck fracture, the total threaded part of the cannulated lag screw broke through the acetabulum into the pelvic cavity. We found a stainless wire, we made a hook in the front, it was introduced into the cannulated screwdriver, then into the cannulated lag screw. The wire was pulled back carefully, the hook kept the tip of the cannulated lag screw engaged. Under properly traction force applied by the stainless wire with a hook, the screwdriver worked in a retro - clockwise manner, the cannulated lag screw was driven back from inside by the screwdriver successfully. Results： A stainless wire with a hook in the front could keep the tip of the cannulated lag screw engaged. The cannulated lag screw under the traction force of the stainless wire could be retrieved. The patient had no complications. The fracture healed uneventfully. Conclusions： Because of osteoporosis, the end of the cannulated lag screw can sink into femoral neck through the lateral cortex . During drilling and screw insertions, screening of the femoral head under the image intensifier should be made frequently. The washer is strongly recommended in the superior eannulated lag screw near the greater trochanter.