欢迎您！东篱公司
退出
-
申报数据库
-
立项数据库
-
成果数据库
-
项目获奖数据库
中文摘要：
目的：探讨非透视下确定顺行股骨髓内钉大转子进钉点的技术方法。方法2007年12月—2008年6月选取10%甲醛溶液固定的成人髋部湿标本8具,男5例、女3例,观察股骨大转子解剖特征,标记大转子上臀中肌、梨状肌的附着情况,观察股骨大转子嵴拐点凹陷、髓腔中轴线与梨状窝的解剖关系。2010年1月—2012年12月对收治的44例股骨转子间及股骨干骨折患者进行前瞻性研究。其中男20例,女24例；年龄25-85岁,平均（66.9±15.7）岁。患者均行顺行髓内钉固定术,术中根据标本解剖中发现大转子嵴拐点凹陷和梨状窝的关系,非透视下通过手法触摸确定髓内钉开口位置。结果尸体标本解剖研究发现,股骨大转子在与股骨颈结合部形成一个向外侧凸出类似“C”形的山嵴样结构。股骨大转子嵴呈后方高、前方平坦下降似斜坡样结构,中间凭借手指就可以感觉有一个类似拐点的凹陷切迹。臀中肌附着在大转子嵴的外侧部分,梨状肌腱附着在大转子嵴拐点切迹的内侧部分。梨状窝就是梨状肌附着点的骨质凹陷,梨状窝基本位于髓腔中轴线上、大转子嵴拐点凹陷的内侧。44例患者中,1例患者术中无法满意确定骨折近端髓腔朝向,开口过程中采用X线透视检查髓腔开口器的方向；43例均在非透视的情况下将髓内钉导针置入髓腔,髓内钉均置入良好。术后随访时间9-28个月,平均18.4个月；除1例股骨干骨折愈合迟缓,动力化后愈合外,其他患者均愈合良好；随访期间所有患者无髓内钉松动、股骨头切出等并发症。结论在股骨干和股骨转子区骨折采用顺行髓内钉固定治疗术中,非透视下通过手法触摸,可以利用大转子嵴拐点凹陷切迹代替梨状窝参考定位,确定髓内钉开口位置,避免反复透视,降低辐射损害。
英文摘要：
Objective To identify the entry points for antegrade femoral nailing without the fluoroscopic guidance.Methods From December 2007 to June 2008,8 cadavers（5 males,3 females）wet adult hip specimens which were 10% formalin-fixed, were used for the observation of the morphological character of the greater trochanter apex, the region that the gluteal muscle and piriformis attached was marked and observed. The anatomical relationship between the greater trochanter crest notch point, the axis of the medullary cavity and piriformis fossa were observed. From January 2010 to November 2012, 44 consecutive patients with intertrochanteric or femur shaft fractures, including 20 males and 24 females;aged 25 to 85 years, mean （66. 9 ± 15. 7） years. All fractures were fixed with antegrade intramedullary nail. The intramedullary nail open position was determined by finger touch without fluoroscopy based the relationship between the greater trochanter crest notch point and piriformis fossa from the cadavers research. Results The greater trochanter near femoral neck portion was similar to the mountain crest-like＂C＂ shaped structure outwardly form overlook in cadaver. The greater trochanter crest was a high posterior portion, flater and lower anterior portion, a depressed notch could be felt by finger in middle of two portions. Gluteus medius attached to the outer portion of the greater trochanter crest, piriformis tendon attached to the inner portion of the greater trochanter crest notch. Piriformis fossa was the bone cave that piriformis tendon attachment point recessed, piriformis fossa substantially in the intramedullary axis, just medial the trochanter crest notch on anteroposterior photographs. Only once fluoroscopy was used to check the entry portal tool direction in 44 patients, because the patient was not satisfied to determine the intramedullary axis of proximal fragment. The other patients were not used anymore fluorcscopy to check the guidewire insert the medullary cavity, and nail were inserted well. All pat
同期刊论文项目
同项目期刊论文
期刊信息
位置：