三枚克氏针技术在加长股骨近端防旋髓内钉远端锁定螺钉置入时的应用

Three Kirschner wire technology for insertion of distal locking screws of lengthened proximal femoral nail antirotation

目的 评价3枚克氏针技术在股骨近端骨折加长股骨近端防旋髓内钉远端锁定螺钉置入时的临床应用效果。方法 纳入自2018-01—2020-01采用加长股骨近端防旋髓内钉内固定治疗的90例老年股骨近端骨折,通过患肢旋转、牵引、有限切开撬拨复位骨折端,开口后置入髓内钉导针,软钻沿导针逐级扩髓后置入加长股骨近端防旋髓内钉主钉,按照标准程序于股骨颈内置入螺旋刀片,远端锁定螺钉采用3枚克氏针技术引导准确置入。结果 术中所有患者均顺利置入远端锁定螺钉,锁钉时间8~12 min,平均9 min。术中X线透视次数为6~10次,平均7次。90例均获得随访,骨折愈合时间12~18个月,平均14个月。术后远端锁钉切口处无渗出、感染。股骨远端无应力性骨折发生,手术侧膝关节活动度对比健侧无明显差异。末次随访时膝关节HSS评分92~97分,平均94分。结论 老年股骨近端骨折加长股骨近端防旋髓内钉内固定术中采用3枚克氏针技术引导准确置入远端锁定螺钉能明显减少X射线暴露、提高锁定成功率。

Objective To investigate the three Kirschner wire technology for insertion of distal locking screws of lengthened proximal femoral nail antirotation. Methods Ninety elderly patients with proximal femur fractures were treated with lengthened proximal femoral nail antirotation from January 2018 to January 2020. All the fractures were reconstructed by the rotated, pulled, and limited incision, the lengthened proximal femoral nail antirotation was inserted after identifying the entry points and expanding the femoral marrow cavity. The spiral blade was inserted into the femoral neck following standard procedures. The distal locking nails were inserted by the three Kirsehner wire technology. Results All distal locking screws were successfully locked, and the time for distal locking ranged from 8 to 12 min (average, 9 min), fluoroscopy frequency were 6-10 times (average, 7 times). All the 90 cases were followed up, the average healing time of the fracture was 12-18 months (average, 14 months). No exudation and infection were found in the distal nail incision, no stress fracture occurred in the distal femur. There was no significant difference in the range of motion of the knee on the operated side compared with that in the contralateral limb. The average score of the last follow-up HSS was 94 points (92-97 points). Conclusion Three Kirschner wire technology can effectively improve the successful rate of locking screws, reduce the fluoroscopy frequency during in insertion of distal locking screws of lengthened proximal femoral nail antirotation.