改进定位器械提高交锁髓内钉远端锁钉置入准确率的临床研究

目的 通过改进交锁髓内钉定位器械提高胫骨远端锁钉置入准确率和手术效率。 方法 选择滁州市第一人民医院骨科自2006年3月-2016年8月收治的37例接受交锁髓内钉内固定治疗的胫骨骨折病例,男性26例,女性11例,年龄20~71岁,平均年龄46.2岁;其中左侧胫骨骨折15例,右侧胫骨骨折22例。所有手术均由同一组医生主刀完成,术中使用改进后的定位器械帮助确定远端锁钉孔,由巡回护士记录两枚远端螺钉成功锁入主钉所需时间和成功锁入螺钉所需次数,术后采用统计学方法检验结果是否具有统计学意义。 结果 所有研究对象共成功置入远端锁钉共74枚,左侧30枚,右侧44枚。2枚螺钉一次锁入成功率高达98.7%,第二枚远端锁钉成功率达到100%,未出现2次以上仍未锁入成功的情况,成功率显著提高。锁入第1枚远端锁钉平均使用时间5.5 min,锁入第2枚锁钉所需平均时间为3.2 min,2枚螺钉用时4~15 min,平均用时8.7 min,锁钉所用时间明显少于改进前所用时间。 结论 术中采用改进后定位压杆可以显著提高交锁髓内钉远端锁钉准确率,减少手术锁钉时间,提高手术质量,同时还兼具经济实惠、成本低廉等优点,适合基层医院推广使用。 

Modified positioning instruments improve the accuracy of interlocking intramedullary nail placement

Objective To improve the accuracy and efficiency of the distal tibial locking nail placement by improving the interlocking intramedullary nail positioning apparatus. Methods Total 37 cases of tibial fractures undergoing internal fixation with interlocking intramedullary nailing in our hospital from March, 2006 to August, 2016 were selected. There were 26 males and 11 females aged 20 to 71 years old, with an average age of 46.2 years. There were 15 cases of left tibia fracture and 22 cases of right tibial fracture. All operations were performed by the same surgeon. The improved positioning instruments were used to help determine the distal locking hole. The time and success rate of locking nails were recorded. Statistical methods were used to judge statistically significant. Results All the subjects were successfully placed in a total of 74 distal locking nails, 30 on the left and 44 on the right. The success rate of two screws was 98.7% and the success rate of the second remote locking nail was 100%. The success rate has been significantly increased (no cases failed with two or more times of locking nails). The average use time of locking the first distal lock was 5.5 min, and the average time required to lock in the second lock was 3.2 min, two screws were used within 4-15 min and the average time was 8.7 min. The time of the lock was significantly less than the time before the improvement. Conclusion The modified location pressure bar can significantly improve the accuracy of interlocking intramedullary nail distal locking, reduce the operative time and improve the quality of operation, and it has the advantages of economical and low cost. It is suitable for popularization and application in primary hospitals.