股骨近端防旋髓内钉Ⅱ置入内固定股骨转子间骨折:徒手导针置入的重要性

Proximal femoral anti-rotation nail Ⅱ fixation repairs intertrochanteric fracture: the importance of unarmed guided needle placement

背景:股骨近端防旋髓内钉用于股骨转子间骨折内固定的效果优于其他内固定材料,徒手插入导针对股骨转子间骨折内固定质量起重要作用。自大转子插入股骨髓腔导针目前缺乏又快又准确的方法。目的:探讨徒手插入导针在股骨近端防旋髓内钉Ⅱ置入内固定修复股骨转子间骨折过程中的操作技巧及应用价值。方法:建立标准的导针插入操作流程。通过辨别自大转子插入股骨髓腔导针尖部的感觉判断导针的位置是否正确,轻微阻力提示导针位置正确,导针贴着股骨内侧皮质在髓腔内下行,经C型臂透视正侧位确认导针位置正确,该过程只需一次正侧位透视;顺畅无阻力提示导针在髓腔之外,需要变换插针方向,不需透视;阻力大一般为针尖刺入股骨内侧骨皮质,需要调整进针方向,或被复位不良的骨折端或脱入髓腔的游离骨折块阻挡,需要进一步整复骨折端。统计分析19例应用股骨近端防旋髓内钉Ⅱ置入内固定修复转子间骨折患者的手术时间、完成导针插入所需时间、出血量、下床负重时间及并发症情况。结果与结论:平均完成内固定的时间为45 min,平均导针插入所需时间为80 s,平均失血量为100 m L。无伤口感染,无压疮形成。下地时间平均为治疗后6周。所有患者均获得随访,随访时间4-9个月。3例治疗前需扶拐行走,治疗后3个月恢复到受伤前运动水平。提示徒手插入导针流程为正确迅速完成导针插入提供了指导方向,从而提高股骨近端防旋髓内钉Ⅱ对股骨转子间骨折的内固定质量,可靠性强,可以明显减少透视次数,缩短手术时间,降低出血量,减少并发症。

BACKGROUND：The effect of proximal femoral anti-rotation nail fixation in repair of intertrochanteric fracture is better than the other fixation materials. Unarmed inserting guided needle plays an important role for the quality of intertrochanteric fracture fixation. At present, there have been short of fast and accurate methods for inserting femoral canal guided needle from trochanter. OBJECTIVE：To investigate the operating skil s and application value of unarmed inserting guided needle in the process of proximal femoral anti-rotation nail Ⅱ fixation in repair of intertrochanteric fracture. METHODS：Standard operating procedures of guided needle inserting were established. The location of the guided needle was correct or was not judged through discriminating the feeling of inserting into the tip of femoral canal guided needle from trochanter. Slight resistance prompted that guided needle was in correct position. The guided needle closed to the medial femoral cortex and moved downward in the medul ary cavity. The guided needle was confirmed in the correct position by the perspective of C-arm in positive side position. This process was just one lateral perspective. Smoothly without resistance prompted that if the guided needle was out of the medul ary cavity, the direction of the inserting needle needed to be changed, without perspective. The resistance would be large if the needle tip piercing the medial femoral cortical bone, at this moment, the direction of the needle needed to be adjusted;or was blocked by malreduction of fracture or the free fracture block off the medul ary cavity;at this moment, fracture ends needed to be further restored. The surgery time, the time required to complete the guided needle inserting, the amount of bleeding, weight-bearing ambulation time and complications of 19 patients with intertrochanteric fracture treated by proximal femoral anti-rotation nail Ⅱ fixation were statistical y analyzed. RESULTS AND CONCLUSION：The average completed time for internal fixation was 45 minutes, the average desired time for guided needle inserting was 80 seconds, the average blood loss was 100 mL. There was no wound infection, or pressure sore formation. The shimoji time was an average of six weeks after treatment. Al patients were fol owed up for 4-9 months. Three patients needed crutches to walk before treatment, and after three months of treatment, they returned to the pre-exercise levels of injury. These results suggest that the procedure of unarmed inserting the guided needle provides guidance for the quick and correct completion of needle inserting, so as to enhance the internal fixation quality of proximal femoral anti-rotation nail Ⅱ in repair of intertrochanteric fracture, with a high reliability. It can significantly reduce the number of perspective, shorten surgery time, reduce the amount of bleeding and reduce complications.