Venkateswaran B, Warner R M, Hunt N, Shaw D L, Tulwa N, Deacon P
Department of Orthopaedics, Pinderfields Hospitals NHS Trust, Wakefield WF1 4DG, UK.
Injury. 2003 Oct;34(10):752-5. doi: 10.1016/s0020-1383(02)00370-4.
Estimating the correct nail length for solid tibial nails can be problematic. Most techniques reported in the literature for determining tibial nail length are not accurate. In a retrospective study of 16 patients in our unit, only three had ideal nail sizes. In these patients, as part of phase I of our study, we measured their normal leg's length from knee joint line to ankle joint line. An ideal nail length for each of these patients was estimated from a whole length radiograph of the nailed tibia. Comparing these two data, we found that deducting 20 mm from the leg measurement gave appropriate nail lengths. We also compared this with three other anthropometric measurements; tibial tuberosity to medial malleolus, joint line to medial malleolus and olecranon to head of V metacarpal head distance. The joint line to joint line measurement was the most reliable and showed the best correlation with ideal nail lengths (0.982). In phase II, a prospective study on 15 patients, we used the joint line to joint line measurement to determine nail sizes. A postoperative review of the radiographs showed all the nails to be of adequate length. This strengthened the fact that the joint line to joint line measurement is the most accurate and easy method to determine tibial nail lengths.
估算实心胫骨髓内钉的正确长度可能存在问题。文献中报道的大多数确定胫骨髓内钉长度的技术并不准确。在我们科室对16例患者的回顾性研究中，只有3例的髓内钉尺寸理想。在这些患者中，作为我们研究第一阶段的一部分，我们测量了他们正常腿部从膝关节线到踝关节线的长度。根据钉入髓内钉的胫骨全长X线片估算出每位患者的理想髓内钉长度。比较这两个数据时，我们发现从腿部测量值中减去20毫米可得出合适的髓内钉长度。我们还将其与其他三种人体测量方法进行了比较；胫骨结节至内踝、关节线至内踝以及鹰嘴至第五掌骨头头部的距离。关节线至关节线的测量最为可靠，且与理想髓内钉长度的相关性最佳（0.982）。在第二阶段，对15例患者进行的前瞻性研究中，我们采用关节线至关节线的测量方法来确定髓内钉尺寸。术后对X线片的复查显示所有髓内钉长度均合适。这进一步证明关节线至关节线的测量是确定胫骨髓内钉长度最准确且简便的方法。
