关节镜下股骨髓内钉经骨窗压杆远端锁定技术

Arthroscopic assisted distal locking of intramedullary nail through a bone fenestration for femoral shaft fracture

[目的]介绍关节镜下股骨髓内钉经骨窗压杆远端锁定的技术方法和临床应用效果。[方法] 2019年1月—2019年11月,12例股骨干骨折髓内钉固定应用此术式。将关节镜伸入骨折断端组织间隙,镜下复位骨折断端。髓内钉顺利进入远端髓腔后,将关节镜伸入股骨远端前方与肌肉之间的间隙,镜下直视钻孔形成骨窗,并通过骨窗置入压杆到髓内钉压杆平台,将螺钉一次性顺利置入远端锁孔并锁定。[结果]手术远端锁定时间为(6.10±7.33) min,远端锁定透视次数(3.00±0.95)次,远端锁钉首次锁定成功率100%,12例患者骨折端均正常愈合。[结论]关节镜下经骨窗压杆是安全的,可以明显缩短手术时间,减少透视次数,简化远端锁定操作。

[Objective] To introduce the surgical technique and preliminary outcomes of arthroscopic assisted distal locking of intramedullary nail through a bone fenestration for femoral shaft fracture. [Methods] A total of 12 patients received intramedullary nailing with this technique for femoral shaft fracture in our hospital from January 2019 to November 2019. An arthroscope was introduced into the tissue space around the fracture site to visualize the fracture reduction directly. As the intramedullary nail was smoothly inserted into the distal medullary cavity, the arthroscope was transferred into the space between the periosteum and muscle in front of the distal femur. Under arthroscopic view, a bone fenestration was made with drill on the anterior cortical bone of distal femur to observe the nail, and then rod of distal guider was placed on the nail accurately. Finally, the distal interlocking screws were inserted under distal guider in routine manner. [Results] The time consumed for distal locking of the intramedullary nail was of(6.10±7.33) min, with fluoroscopy of(3.00±0.95) times. The accurate rate of distal interlocking screw placement was 100% at the first time in the 12 patients. By the time of latest follow up, all the 12 patients got sound fracture healing. [Conclusion] This arthroscopic assisted distal locking of femoral intramedullary nail through a bone fenestration is safe and effective technique, which does significantly shorten the operation time, reduce use frequency of C-arm intensifier, and simplify operation of distal locking.