弯针技术在耻骨支骨折中的应用

Application of bending needle technique in fracture of pubic branch

目的探讨弯针技术在耻骨支骨折置入中的应用。方法回顾性分析湖南省常德市第一中医医院创伤二科在2017年1月-2021年1月对无明显移位或轻中度移位的耻骨支骨折经皮微创置入空心螺钉的66例(82处)患者资料。随机分为两组,观察组均使用弯针技术(即以6.5 mm钛质空心拉力螺钉充当“骨折复位器”,以2.0 mm的克氏针当髓腔导针,精准置入空心钉)置入42枚耻骨支螺钉,所有患者于伤后3~7 d围手术期稳定后在C臂机引导下行手术治疗;对照组常规置入40枚耻骨支螺钉。观察并记录两组患者术后骨折复位情况与单枚螺钉置入时间。结果66例患者共置入82枚空心螺钉,术后骨盆正位、骨盆出入口位及骨盆CT三维成像证实所有置入的螺钉均顺利通过耻骨支通道,未见螺钉穿出情况发生。采用Matta标准评价术后手术复位情况,对照组:优31处,良5处,可4处,优良率90.00%。观察组:优39处,良2处,可1处,优良率97.62%,P<0.05差异具有统计学意义;组间单枚置入时间比较,差异有统计学意义(P<0.05)。结论采用弯针技术可以很好地解决耻骨支通道狭窄、不规则、置钉困难的问题,减少透视次数,提高置钉准确率,值得推广。

Objective To investigate the application of bending technique in implantation of pubic branch fracture.Methods Retrospective analysis of 66 patients(82 places)implanted with hollow screws in the second Department of Trauma of the First Traditional Chinese Medicine Hospital of Changde City,Hunan Province from January 2017 to January 2021 was done.All patients of observation group applied bending technique with 6.5 mm titanium hollow tensile screw as the"fracture retractor"and 2.0 mm cruzi needle as a myeloid needle,and all patients were operated under the guidance of C-arm machine 3 to 7 days after injury.The observation group used the bending needle technique to insert 40 pubic branch screws,and 42 pubic branch screws were routinely implanted in the control group to observe and record the postoperative fracture reduction and the single screw insertion time.Results Eighty-two hollow screws were implanted in 66 patients,and 82 pelvic orientation and pelvic CT imaging confirmed that 82 screws were in the channel and none penetrated the channel cortex.Matta standard:the control group was 31 excellent,5 good,4 good,and the excellent rate was 90.00%.In the observation group,39 excellent,2 good,fair one,the excellent rate of 97.62%.P<0.05,the difference was significant,single entry time had significant difference between groups(P<0.05).Conclusion The problem of narrow,irregular and implantation difficulty can be resolved by bending needle technique,reduce the number of perspective and improve the implantation accuracy,It is worth of promotion.