Grützner P, Hochstein P, Simon R, Wentzensen A
Unfallchirurgische Klinik, Berufsgenossenschaftliche Unfallklinik Ludwigshafen.
Chirurg. 1999 Mar;70(3):276-84. doi: 10.1007/s001040050643.
In the treatment of femoral and tibial fractures the frontal and sagittal planes are controlled and documented by conventional X-ray films. Computed tomography permits exact measurement of the coronal plane. Between June 1993 and December 1997, 161 computed tomographic measurements of femoral torsion and 55 of tibial torsion after shaft fracture were carried out. The results were analyzed in a clinical study. A CT examination was carried out if the clinical examination aroused suspicion of a difference in torsion. 28.5% of the patients examined with femoral fractures and 23.8% of those with tibial fractures and torsion differences of more than 20 degrees. Between June 1993 and June 1997, 30 corrective derotating osteotomies of the femur and 9 of the tibia were carried out. The average preoperative difference of torsion of the femur was 29 degrees and of the tibia 25 degrees. After the operation the average femur difference was 7 degrees and of the lower leg 6.5 degrees, which are inside normal physiological limits. The osteotomies were carried out in the metaphysis near the fracture. Additional corrections in other planes were necessary on the femur in 27% and on the lower leg in 46%. With the aim of avoiding torsion differences, or at least to recognize them at an early stage, CT measurements of torsion after osteosythetic treatment of fresh unilateral femur-shaft fractures were carried out in 49 patients between October 1996 and December 1997. The torsion measurements during the operations had to be carried out clinically. No sufficiently exact method of measurement is available in the operating room. Three patients with increased differences of 28 degrees, 26 degrees or 19 degrees had their osteosyntheses corrected. The measurements after correction were inside the normal spread.
在股骨和胫骨骨折的治疗中，额状面和矢状面通过传统X线片进行控制和记录。计算机断层扫描可精确测量冠状面。1993年6月至1997年12月期间，对161例股骨干骨折后的股骨扭转和55例胫骨干骨折后的胫骨扭转进行了计算机断层扫描测量。在一项临床研究中对结果进行了分析。如果临床检查怀疑存在扭转差异，则进行CT检查。接受股骨骨折检查的患者中有28.5%以及接受胫骨骨折检查且扭转差异超过20度的患者中有23.8%。1993年6月至1997年6月期间，对30例股骨进行了矫正旋转截骨术，对9例胫骨进行了矫正旋转截骨术。股骨术前扭转平均差异为29度，胫骨为25度。术后股骨平均差异为7度，小腿为6.5度，均在正常生理范围内。截骨术在骨折附近的干骺端进行。股骨有27%、小腿有46%需要在其他平面进行额外矫正。为避免扭转差异，或至少在早期识别它们，1996年10月至1997年12月期间对49例新鲜单侧股骨干骨折进行骨内固定治疗后的扭转进行了CT测量。手术中的扭转测量必须在临床上进行。手术室中没有足够精确的测量方法。3例扭转差异增加至分别为28度、26度或19度的患者对其骨内固定进行了矫正。矫正后的测量值在正常范围内。
