一种新型超远端锁具在髓内钉治疗胫骨骨折中的应用

A new ultradistai locking tool in intrameduUary nailing for tibial fractures

目的探讨一种新型超远端锁具在髓内钉治疗胫骨骨折中的临床意义。方法回顾性分析2014年1月至2016年5月采用胫骨髓内钉治疗的175例胫骨骨折患者资料。男119例，女56例；年龄19—73岁，平均46．3岁。根据术中胫骨髓内钉瞄准器的不同将患者分为2组：自2014年1月至2015年1月采用传统压杆瞄准器治疗者83例（传统瞄准器组），自2015年2月至2016年5月采用新型超远端锁具治疗者92例（新型超远端锁具组）。比较两组患者手术时间、术中透视次数、远端锁钉1次锁定成功率等数据。结果传统瞄准器组和新型超远端锁具组胫骨骨折患者的一般资料比较差异均无统计学意义（P〉0．05），具有可比性。新型超远端锁具组患者平均手术时间（59．8±4．3）min、平均透视次数（11．0±2．1）次、1次锁钉成功率94．4％（238／252）均优于传统瞄准器组患者[（73．6±5．3）min、（23．0±3．8）次、85．7％（180／210）]，差异均有统计学意义（P〈0．05）。结论新型胫骨髓内钉超远端锁具在手术时间、术中透视次数及远端锁钉1次锁定成功率等方面均优于传统远端锁定瞄准器，且其操作简便、无需额外费用、易于推广，是胫骨髓内钉远端锁定的一种较为实用的方法。

Objective To evaluate the clinical application of our self-designed ultradistal locking tool in the intramedullary nailing for tibial fractures. Methods From January 2014 to May 2016, 175 patients with tibial fracture were treated at our department. They were 119 men and 56 women, from 19 to 73 years of age （average, 46. 3 years）. They were divided into 2 groups according to the different targeting devices used in the intramedullary nailing. Conventional locking tools were used in the 83 patients from January 2014 to January 2015 and our self-designed new ultradistal locking tools in the 92 patients from February 2015 to May 2016. The 2 groups were compared in terms of operation time, frequency of intraoperative fluoroscopy, and successful rate of one-time locking. Results There were no significant differences between the 2 groups in general clinical data（ P 〉 0. 05）, showing similarities of the 2 groups. The operation time（59. 8 ±4. 3 min）, frequency of intraoperative fluoroscopy（11. 0 ± 2. 1 times）, and rate of one-time successful locking[94.4% （238/252） ] in the ultradistal locking group were significantly better than those in the conventional locking group [73.6±5.3min, 23. 0 ± 3. 8 times and 85. 7% （180/210）, respectively]（P 〈0.05）. Conclusions Our new ultradistal locking tools are superior to the conventional ones in that they lead to shorter operation time, less intraoperative fluoroscopy and higher successful rate of one-time locking. Additionally, the new locking tools are easy to handle and incur no extra costs.