脛骨骨折閉合復位手術架的設計與臨床應用_《中國修復重建外科雜志》

作者：

董文偉 , 史增元 , 劉振新 , 許海平

寧波大學醫學院附屬醫院創傷骨科（浙江寧波，315000）;

關鍵詞：

脛骨骨折髓內釘閉合復位脛骨骨折閉合復位手術架

DOI：

10.7507/1002-1892.20130280

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的介紹一種自制脛骨骨折閉合復位手術架，評價其臨床應用效果。方法 2010年6月－2012年12月，采用自制脛骨骨折閉合復位手術架，閉合復位髓內釘固定治療24例脛骨骨折。其中男18例，女6例；年齡20～64歲，平均40歲。均為閉合骨折；骨折部位：脛骨近1/3骨折3例，中1/3骨折12例，遠1/3骨折9例。骨折按AO分型：A型12例，B型8例，C型4例。傷后至手術時間1～12 d，平均3 d。記錄閉合復位骨折透視次數、術中證實導針通過骨折端透視次數以及骨折復位至主釘插入手術時間；術后根據Freedman等方法測量患肢力線及骨折端成角，采用Johner-Wruhs脛骨干骨折評分標準評定患肢功能。結果通過應用脛骨骨折閉合復位手術架，24例患者均順利完成骨折閉合復位。閉合復位骨折透視次數為2～5次，平均3次；術中證實導針通過骨折端透視次數均為2次；骨折復位至主釘插入手術時間20～42 min，平均30 min。術中、術后均無感染及血管、神經損傷等并發癥發生。切口均Ⅰ期愈合。17例獲隨訪，隨訪時間6～16個月，平均10個月。骨痂形成時間2～4個月，平均2.5個月。術后5個月攝患肢正側位X線片，根據Freedman等方法測量患肢力線均正常，骨折端無明顯成角畸形；內固定物位置良好。采用Johner-Wruhs脛骨干骨折評分標準評定患肢功能：獲優12例，良5例，優良率100%。結論脛骨骨折閉合復位手術架結構簡單、操作簡便，輔助閉合復位髓內釘固定治療脛骨骨折臨床效果理想。

引用本文： 董文偉,史增元,劉振新,許海平. 脛骨骨折閉合復位手術架的設計與臨床應用. 中國修復重建外科雜志, 2013, 27(11): 1281-1285. doi: 10.7507/1002-1892.20130280 復制

1.	Brumback RJ. The rationales of interlocking nailing of the femur, tibia, and humerus. Clin Orthop Relat Res, 1996, (324): 292-320.
2.	Bhandari M, Guyatt GH, Swiontkowski MF, et al. Surgeon’s preferences for the operative treatment of fractures of the tibial shaft. J Bone Joint Surg (Am), 2001, 83-A(11): 1746-1752.
3.	Arbuthnot JE, Perera A, Powers D. Primary rigid intramedullary nail for fractures of the tibia: current concepts and techniques. Eur J Orthop Surg Traumatol, 2008, 18(6): 435-440.
4.	Robertson A, Giannoudis PV, Matthews SJ. Maintaining reduction during undreamed nailing of a segmental tibial fracture: the use of a Farabeuf clamp. Injury, 2003, 34(5): 389-391.
5.	Malik MHA, Harwood P, Diggle P, et al. Factors affecting rates of infection and nonunion in intramedullary nailing. J Bone Joint Surg (Br), 2004, 86(4): 556-560.
6.	Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res, 1995, (315): 25-33.
7.	Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
8.	Seyhan M, Kocaoglu B, Nalbantoglu U, et al. A positioning technique for closed intramedullar nailing of tibia fractures. J Trauma, 2008, 64(5): 1408-1411.
9.	Hill RA, Albert JS. Patient positioning for closed locked tibial nailing. Injury, 1990, 21(3): 193-194.
10.	McBirnie JM, Burnett R. A traction technique for intramedullary nailing of tibial fractures. Injury, 1996, 27(10): 733-734.
11.	Gibbons CE, Solan MC, Bendall SP. The use of the ankle arthroscopy strap during intramedullary tibial nailing. Injury, 1999, 30(1): 72-73.
12.	Jackson M, Topliss CJ, Atkins RM. Fine wire frame-assisted intramedullary nailing of the tibia. J Orthop Trauma, 2003, 17(3): 222-224.
13.	Moed BR, Watson JT. Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique. J Orthop Trauma, 1994, 8(3): 195-202.
14.	Krause PC, Whatley AN, Mautner JF. A technique for nailing severely shortened and displaced tibia fractures. J Orthop Trauma, 2008, 22(2): 138-141.
15.	高士濂. 實用解剖圖譜: 下肢分冊. 2版. 上海: 上海科學技術出版社, 2004: 140-247.
16.	Vernon P, Delattre JF, Johnson EJ, et al. Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee. Surg Radiol Anat, 1987, 9(1): 37-41.
17.	周錦年, 高劍銳, 路通. 交鎖髓內釘治療脛骨骨折87例報告. 中華創傷骨科雜志, 2008, 10(4): 395-396.
18.	Sarangi PP, Karachalios T. Posterior tibial nerve palsy after intramedullary nailing. Int Orthop, 1993, 17(2): 125-126.
19.	Robinson CM, Donnell JO, Will E, et al. Dropped hallux after the intramedullary nailing of tibial fractures. J Bone Joint Surg (Br), 1999, 81(3): 481-484.

1. Brumback RJ. The rationales of interlocking nailing of the femur, tibia, and humerus. Clin Orthop Relat Res, 1996, (324): 292-320.
2. Bhandari M, Guyatt GH, Swiontkowski MF, et al. Surgeon’s preferences for the operative treatment of fractures of the tibial shaft. J Bone Joint Surg (Am), 2001, 83-A(11): 1746-1752.
3. Arbuthnot JE, Perera A, Powers D. Primary rigid intramedullary nail for fractures of the tibia: current concepts and techniques. Eur J Orthop Surg Traumatol, 2008, 18(6): 435-440.
4. Robertson A, Giannoudis PV, Matthews SJ. Maintaining reduction during undreamed nailing of a segmental tibial fracture: the use of a Farabeuf clamp. Injury, 2003, 34(5): 389-391.
5. Malik MHA, Harwood P, Diggle P, et al. Factors affecting rates of infection and nonunion in intramedullary nailing. J Bone Joint Surg (Br), 2004, 86(4): 556-560.
6. Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res, 1995, (315): 25-33.
7. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
8. Seyhan M, Kocaoglu B, Nalbantoglu U, et al. A positioning technique for closed intramedullar nailing of tibia fractures. J Trauma, 2008, 64(5): 1408-1411.
9. Hill RA, Albert JS. Patient positioning for closed locked tibial nailing. Injury, 1990, 21(3): 193-194.
10. McBirnie JM, Burnett R. A traction technique for intramedullary nailing of tibial fractures. Injury, 1996, 27(10): 733-734.
11. Gibbons CE, Solan MC, Bendall SP. The use of the ankle arthroscopy strap during intramedullary tibial nailing. Injury, 1999, 30(1): 72-73.
12. Jackson M, Topliss CJ, Atkins RM. Fine wire frame-assisted intramedullary nailing of the tibia. J Orthop Trauma, 2003, 17(3): 222-224.
13. Moed BR, Watson JT. Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique. J Orthop Trauma, 1994, 8(3): 195-202.
14. Krause PC, Whatley AN, Mautner JF. A technique for nailing severely shortened and displaced tibia fractures. J Orthop Trauma, 2008, 22(2): 138-141.
15. 高士濂. 實用解剖圖譜: 下肢分冊. 2版. 上海: 上海科學技術出版社, 2004: 140-247.
16. Vernon P, Delattre JF, Johnson EJ, et al. Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee. Surg Radiol Anat, 1987, 9(1): 37-41.
17. 周錦年, 高劍銳, 路通. 交鎖髓內釘治療脛骨骨折87例報告. 中華創傷骨科雜志, 2008, 10(4): 395-396.
18. Sarangi PP, Karachalios T. Posterior tibial nerve palsy after intramedullary nailing. Int Orthop, 1993, 17(2): 125-126.
19. Robinson CM, Donnell JO, Will E, et al. Dropped hallux after the intramedullary nailing of tibial fractures. J Bone Joint Surg (Br), 1999, 81(3): 481-484.

下一篇
兩種方法治療脛骨遠端關節外骨折療效比較

《中國修復重建外科雜志》

脛骨骨折閉合復位手術架的設計與臨床應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

下一篇

Format

Content

《中國修復重建外科雜志》

脛骨骨折閉合復位手術架的設計與臨床應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料