非透视下确定顺行股骨髓内钉大转子进钉点的解剖观察与运用

袁广斌，慕礼健，鲍立志

（陕西省榆林市靖边县中医医院骨伤科，陕西 榆林，718500）

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摘要：

目的 探究非透视下确定顺行股骨髓内钉大转子进钉点的运用效果。方法 对10具成人髋部湿标本展开分析，分析其股骨大转子解剖特征等情况，为非透视下确定进钉点提供理论依据。将我院2002年4月至2015年4月收治的203例骨折且需行顺行髓内钉固定术治疗的患者作为观察对象，观察非透视下确定进钉点的临床应用效果。结果 标本解剖发现，大转子、股骨颈间呈凹陷似山嵴样状态，梨状窝与大转子嵴拐点凹陷有一定的关系。在非透视下确定进钉点后，转子间骨折患者住院时间短于股骨干骨折患者（P<0.05），但是在手术时间、术中出血量方面，两种骨折患者差异不显著（P>0.05）；直型股骨髓内钉治疗患者的骨折复位不佳、骨折愈合迟缓、股骨头切出发生率高于PFNA髓内钉治疗患者（P<0.05）。结论 非透视下确定进钉点在转子间骨折和股骨干骨折患者的PFNA髓内钉治疗中应用效果显著，值得临床推广应用。

关键词：标本解剖；骨折固定术；髓腔朝向；非透视；进钉点

中图分类号：R687.3文献标志码：A文章编号：2096-1413(2017)22-0095-02

Anatomical observation and application of identifying the insertion point in the greater trochanter for antegrade femoral intramedullary nailing without the fluoroscopic guidance
YUAN Guang-bin, MU Li-jian, BAO Li-zhi
(Department of Orthopedics, Jingbian County Hospital of Traditional Chinese Medicine, Yulin 718500, China)

ABSTRACT: Objective To investigate the effect of identifying the insertion point in the greater trochanter for antegrade femoral intramedullary nailing without the fluoroscopic guidance. Methods Ten adult hip wet specimens were observed to analyze the anatomical characteristics of femoral trochanter and provide reference for identifying the insertion point without the fluoroscopic. From April 2002 to April 2015, 203 cases of patients with fracture in our hospital who needed to be treated with antegrade intramedullary nailing were selected as the observation objects, then the treatment effect of non-fluoroscopy for identifying of nail point was analyzed. Results Specimen anatomy showed that large rotor, femoral neck was concave like mountain ridge -like state, pear -shaped fossa and the big rotor crest point of depression had certain relationship. After identifying the insertion point without the fluoroscopic guidance, the hospital stay of patients with intertrochanteric fractures were shorter than those with femoral shaft fractures (P<0.05), but the differences in operation time, intraoperative blood loss were not significant (P>0.05); the patients with straight femoral intramedullary nails had higher incidence rate of fracture reduction, delayed fracture healing and femoral head resection than those in patients with PFNA intramedullary nail (P<0.05). Conclusion The effect of non -fluoroscopy in the treatment of patients with intertrochanteric fractures and fe moral shaft fractures and treated with PFNA intramedullary nail is significant, which is worthy of promotion and application. KEYWORDS: specimen anatomy; fracture fixation; medullary cavity orientation; non-perspective; insertion point

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