Sureshot远端瞄准系统在股骨髓内钉远端锁钉过程中的应用

SURESHOT Distal Targeting System used for insertion of distal locking screws of tibial intramedullary nails

目的比较Sureshot远端瞄准系统与徒手瞄准方法在股骨髓内钉远端锁钉过程中的应用效果。方法将2013年5月至2014年5月期间应用Sureshot远端瞄准系统进行股骨髓内钉远端锁钉操作的42例股骨干骨折患者作为研究组，同期应用徒手瞄准方法进行远端锁钉操作的44例患者作为对照组。研究组男30例，女12例；平均年龄为（37．5±2．8）岁；骨折AO分型：32．A型18例，32．B型14例，32．c型10例。对照组男32例，女12例；平均年龄为（38．2±3．1）岁；骨折AO分型：32．A型20例，32．B型13例，32-C型11例。回顾性比较两组患者远端交锁螺钉操作时间、一次性锁定成功率、远端锁定透视次数、骨折愈合时间及美国特种医院膝关节评分等。结果研究组患者远端交锁螺钉操作时间【（7．3±1．5）min】显著短于对照组患者【（10．8±2．6）min]，一次性锁定成功率（100％）显著高于对照组患者（83％），远端锁定透视次数【（1．0±0．5）次】显著少于对照组患者【（5．0±2．3）次]，差异均有统计学意义（P〈0．05）；而骨折愈合时间【（25．5±3．6）厨】、美国特种医院膝关节评分[（92±3）分】与对照组患者【（26．3±4．7）周、（91±3）分]比较差异均无统计学意义（P〉0．05）。结论与徒手瞄准固定相比，采用Sureshot远端瞄准系统进行远端锁钉的置入具有操作简便、定位准确的优点，可以有效提高远端锁钉的锁定成功率、缩短手术时间、减少放射线暴露量。

Objective To compare SURESHOT Distal Targeting System with free-hand technique in the distal locking process of femoral intramedullary nails. Methods From May 2013 to May 2014, we treated 42 patients with femoral shaft fracture with the SURESHOT Distal Targeting System （study group） and 44 similar patients with free-hand technique （control group） in the distal locking process of intramedullary nails. The study group had 30 males and 12 females, with a mean age of 37.5 ±2. 8 years. By AO classification, they were 18 cases of type 32-A, 14 ones of type 32-B and 10 ones of type 32-C. The control group had 32 males and 12 females, with a mean age of 38.2 ± 3.1 years. They were 20 cases of type 32-A, 13 ones of type 32 -B and 11 ones of type 32-C. The 2 groups were compared in terms of time for distal locking, once locking rate, fluoroscopy frequency, fracture healing time, and The Hospital for Special Surgery （HSS） score. Results The time for distal locking in the study group （7.3 ± 1.5 minutes） was significantly shorter than in the control group （10. 8 ±2.6 minutes）, the once locking rate in the study group （100%） was significantly higher than in the control group （83%）, and the fluoroscopy frequency in the study group （ 1.0 ± 0. 5 times） was significantly lower than in the control group （5.0 ± 2.3 times） （ P 〈 0.05）. There were no significant differences between the 2 groups in fracture healing time （25.5 ± 3.6 weeks versus 26.3 ± 4. 7 weeks） or HSS score of the knee（92 ± 3 versus 91 ± 3） （ P 〉 0. 05）. Conclusion Compared with free-hand technique, the SURESHOT Distal Targeting System used in the distal locking of intramedullary nails can significantly improve once locking rate, reduce distal locking time, and more importantly, decrease the radiation exposure.