股骨髓内钉远端锁钉置入的模型骨实验

背景：髓内钉置入内固定是治疗股骨干骨折的经典方案，其远端瞄准架被广泛应用于远端锁钉的置入，提高了远端锁钉置入的准确率，但其失败率仍然不容忽视。研究出一种可实现远端锁钉快速且精准锁钉的新技术，减少徒手锁钉时的X射线放射性损伤，是当务之急。目的：比较占位压杆技术和徒手锁钉技术在股骨髓内钉远端锁钉置入中的效果。方法：建立发生压杆偏移不能准确置入远端锁钉的股骨模型骨8个，分2组处理：占位压杆组（n=4）采用占位性压杆技术，在原压杆孔相邻位置重新钻孔后进行准确压杆，再进行远端锁钉孔斯氏针的置入；徒手锁钉组（n=4）采用C臂监视下的徒手锁钉技术完成远端锁钉孔斯氏针的置入。比较两组置钉的X射线曝光次数、锁钉时间及置钉准确率。结果与结论：（1）占位压杆组X射线曝光次数少于徒手锁钉组（P <0.05），锁钉时间短于徒手锁钉组（P <0.05）；两组的置钉准确率均为100%；（2）结果表明，占位压杆技术和徒手锁钉技术均能准确地完成股骨髓内钉远端锁钉的置入，占位压杆技术相比徒手锁钉技术具有手术时间短和X射线辐射少的优点。

Model bone experiment of distal locking placement with femoral intramedullary nail

BACKGROUND: Intramedullary nail is a classical scheme for the treatment of femoral shaft fracture. Its distal aiming frame is widely used in the placement of distal locking nail, which improves the accuracy of distal locking nail placement, but its failure rate cannot be ignored. It is urgent to develop a new technology that can actualize the rapid and accurate locking of distal locking nail and reduce the X-ray radiation damage of bare-handed locking nail. OBJECTIVE: To compare the effect of place-occupying compression rod technique and bare-hand locking nail technique in distal locking nail placement of femoral intramedullary nail. METHODS: The eight model bones with the deviation of the compression rod that could not be accurately placed into the distal locking nail were divided into two groups. The place-occupying compression rod group (n=4) adopted the place-occupying compression rod technology. After drilling the hole adjacent to the original pressure rod hole, the accurate pressing rod was carried out, and then the distal locking nail placement carried on. In the bare-hand locking nail group (n=4), the technique of bare-hand nail under the supervision of C-arm was used to complete the placement of locking nail in the distal locking hole. The X-ray exposure times, nail locking time and nail placement accuracy were compared between the two groups. RESULTS AND CONCLUSION: (1) The number of X-ray exposure in the place-occupying compression rod group was significantly less than that in the bare-hand locking nail group (P < 0.05). The time of locking nail in the place-occupying compression rod group was significantly shorter than that in the bare-hand locking nail group (P < 0.05). The accuracy of nail placement in both groups was 100%. (2) The results showed that the technique of place-occupying compression rod and the technique of bare-hand locking nail could complete the placement of distal locking nail accurately, and the technique of place-occupying compression rod has the advantages of shorter operation time and less X-ray radiation compared with the technique of bare-hand locking nail. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.