经骨隧道镜下股骨颈断裂克氏针取出

Taking out broken guide wire in femoral neck with intramedullary bone endoscopy

[目的]介绍经骨隧道镜下股骨颈断裂克氏针取出的手术技术和初步临床效果。[方法]2011年3月—2020年5月本院骨科共收治股骨颈克氏针断裂7例。影像检查确定断裂克氏针的深度,取出原固定空心钉,用空心环钻沿克氏针向近端延长骨隧道,X线透视下略超过克氏针断端时停止,置入关节镜,直视下寻找断裂的克氏针残余,置入夹持钳,确定夹住针尾后,拔出断裂的克氏针,骨隧道内植骨。[结果]所有患者均顺利完成手术,手术时间(23.30±3.90)min,出血量(16.20±4.40)ml。骨隧道近端与关节面距离(1.80±1.00)cm。末次随访时X线片显示骨隧道植骨区骨愈合,未出现内固定松动或内固定周围骨吸收,也未出现股骨颈骨折。髋关节Harris功能评分(84.40±4.64)分。[结论]经骨隧道关节镜技术应用于股骨颈断裂克氏针取出,具有损伤小、高效的优点,术中无需额外破坏隧道周围骨质,断针取出后可以继续执行内固定计划。

[Objective]To introduce the surgical technique and preliminary outcomes of taking out broken guide wire in femoral neck with intramedullary bone endoscopy.[Methods]Between March 2011 and May 2020,7 patients had broken guide wire in femoral neck removed by intramedullary bone endoscopy in our department.After imaging check to determine the depth of the broken wire,the original fixed cannulated screw was taken out,and the original bone tunnel was enlarged with a cannulated drill,which stopped as just beyond the distal end of the broken wire under X-ray fluoroscopy.As the arthroscope was introduced into the bone tunnel,the broken wire was identified with a small curett.A grasp forceps was introduced into the tunnel to hold the retained wire,and pulled back to take out the broken wire.Finally,bone grafts were inserted into the tunnel.[Results]All patients underwent successful operation with operation time of(23.30±3.90)min,blood loss of(16.20±4.40)ml and the distance between proximal bone tunnel and articular surface of(1.80±1.00)cm.Radiographs at the latest follow-up showed bone union in the bone tunnel graft area with no loosening of fixation or bone resorption around fixation,and no femoral neck fracture.The Harris score was of(84.40±4.64)at the latest follow up.[Conclusion]Removal of broken guide wire in femoral neck with intramedullary bone endoscopy is efficient,and has benefits of minimalizing iatrogenic trauma,no additional damage to the tunnel,and maintaining the original internal fixation.