微调装置辅助下股骨髓内钉远端锁钉的置入效果

Insertion of distal interlocking of femoral intramedullary nails with vernier device

背景:髓内钉是治疗股骨干骨折的“金标准”,但股骨髓内钉远端锁钉的置入一直是个难题。目的:比较微调装置辅助下徒手股骨髓内钉远端锁钉置入与单纯徒手置钉的效果。方法:纳入2017-2021年南京鼓楼医院集团宿迁医院骨科收治的股骨干、股骨转子部骨折患者63例,共计64侧肢体股骨骨折,采用随机数字表法分为2组:微调装置组(32侧)在微调装置辅助下进行徒手股骨髓内钉远端锁钉置入,徒手操作组(32侧)进行徒手股骨髓内钉远端锁钉置入。比较两组从开始到透视形成正圆图像的时间和透视次数,置钉成功的时间和透视次数,锁钉置入操作的总时间。结果与结论:微调装置组从开始操作C臂到正圆形成的时间和透视次数少于徒手操作组(P<0.001),从正圆形成到C臂确认置钉成功的时间和透视次数少于徒手操作组(P<0.001),锁钉置入操作的总时间少于徒手操作组(P<0.001)。结果表明,相较于单纯徒手置钉,微调装置辅助置钉速度快、间接辐射少,无直接辐射暴露,无需专门设计装置,是值得推广的一项锁钉技术。

BACKGROUND:Intramedullary nail is the"gold standard"for the treatment of femoral shaft fractures,but the placement of distal locking of the femoral intramedullary nail has always been a difficult problem.OBJECTIVE:To compare the effectiveness between unarmed and vernier device support groups for distal inte rlocking screws in femoral nails.METHODS:Totally 63 patients with femoral shaft and trochanteric fractures(64 sides)were enrolled from Department of Orthopedics,Nanjing Drum Tower Hospital G roup Suqian Hospital from 2017 to 2021.They were randomly divided into two groups.In the vernier device support group(32 cases),unarmed femoral intramedullary nail placement and internal fixation were conducted with vernier device support.In the unarmed group(32 cases),unarmed femoral intramedullary nail distal locking screw placement and internal fixation were conducted.The operation time and X-ray count for a perfect circle image,the time and the number of fluorosco py when the nail was successfully placed,and the total time of the locking nail insertion were compared between unarmed and vernier device support groups.RESULTS AND CONCLUSION:The operation time and X-ray count for a perfect circle image of the vernier device support group were less than those in the unarmed group(P<0.001).The time and the number of fluoroscopy when the nail was successfully placed of the vernier device support group were less than those in the unarmed group(P<0.001).The total time of the locking nail inse rtion of the vernier device support group was less than that in the unarmed group(P<0.001).The results show that,compared with the unarmed nail placement,the vernier device support placement has faster locking speed,less indirect radiation,no direct radiation exposure,and no need for a specially designed device.It is a locking nail technology worthy of promotion.