自制摇杆器辅助闭合复位髓内钉固定股骨干骨折

A self-developed rocker for closed reduction and intramedullary nailing for femoral shaft fractures

[目的]介绍一种自制的双针摇杆器辅助闭合复位顺行髓内钉治疗股骨干骨折的手术技术及初步临床效果。[方法]2018年1月—2021年3月,13例股骨干骨折患者接受上述手术治疗。股骨近端扩髓插入金手指,骨折远端合适位置置入2枚3.0克氏针,安装好自制摇杆器并拧紧尾帽实施锁定,金手指配合自制摇杆器在透视下复位并顺利插入导针,顺导针插入主钉并完成锁定。[结果]13例患者均顺利完成闭合顺行髓内钉内固定手术,术后无严重并发症发生,手术时间(100.4±12.8)min,术中出血量(170.2±28.3)ml,术中透视(34.0±5.1)次。临床骨折愈合时间12~17周,平均(13.8±1.3)周。VAS评分由术后3d(3.5±1.0)显著减少至末次随访时(0.4±0.7)(P<0.001),KSS评分由术后3 d的(43.5±8.8)显著增加至末次随访(95.8±2.6)(P<0.001)。[结论]自制锁定双针摇杆器有利于股骨干骨折术中闭合复位,提升顺行髓内钉固定的手术效率。

[Objective]To introduce the surgical technique and preliminary clinical outcomes of a self-made double-pin rocker assisted closed reduction and anterograde intramedullary nail for femoral shaft fracture.[Methods]From January 2018 to March 2021,13 patients received the above surgical treatment for femoral shaft fracture.As the proximal femoral medullar cavity was opened,a cannulated lever,the“gold finger”was inserted over the guide pin.Subsequently,two pin 3.0 mm in diameter were percutaneously placed in the appropriate position at the distal fragment of the fracture,and the self-made rocker was attached with the pins by tightening the end caps.Using the“gold finger”and rocker as the levers,the fracture was reduced,and maintained in reduced position easily under fluoroscopy,then the guide pins were passed through the fracture gap successful,followed by the main nail inserted and locked.[Results]All the patients had closed reduction and anterograde intramedullary nail fixation performed successfully without serious postoperative complications,while with operation time of(100.4±12.8)min,intraoperative blood loss of(170.2±28.3)ml,and intraoperative fluoroscopy of(34.0±5.1)times.Clinical fracture healing time ranged from 12 weeks to 17 weeks with an average of(13.8±1.3)weeks.The VAS score significantly decreased from(3.5±1.0)at 3 days postoperatively to(0.4±0.7)at the latest follow-up(P<0.001),while the KSS score significantly increased from(43.5±8.8)to(95.8±2.6)at the final interview(P<0.001).[Conclusion]This self-made double-pin rocker is beneficial to the closed reduction of femoral shaft fracture,therefore improve the efficiency of anterograde intramedullary nail fixation.