两种辅助肱骨、股骨和胫骨骨折交锁髓内钉修复的技术:12只犬猫的实验结果

Two techniques for supplementing interlocking nail repair of fractures of the humerus, femur, and tibia: results in 12 dogs and cats.

作者信息

Basinger R Randy, Suber Jonathan T

机构信息

South Carolina Surgical Referral Service, 124 Stonemark Lane, Columbia, SC 29210, USA.

出版信息

Vet Surg. 2004 Nov-Dec;33(6):673-80. doi: 10.1111/j.1532-950X.2004.04095.x.

Abstract

OBJECTIVE

To describe 2 devices for improving stabilization of inadequately stabilized interlocking nail (ILN) repairs of the humerus, tibia, and femur in dogs and cats.

STUDY DESIGN

Prospective study.

ANIMALS

Twelve client-owned dogs and cats.

METHODS

Two devices to further stabilize ILN repair of inadequately stabilized diaphyseal fractures were developed. Device 1 was an axial extension for the ILN that was connected to a conventional type I external skeletal fixator (ESF) with a short connecting bar. Device 2 had hybrid ILN bolt/ESF pins that were used to lock the ILN and serve as the pins for a type I ESF. Devices were used at the initial surgery when the stability of ILN repair was considered inadequate based on palpable fracture segment movement, insufficient medullary canal filling of the ILN at the fracture site, or when the ILN was used in a buttress mode. Outcome was obtained by recheck examinations, radiography, and telephone interview.

RESULTS

Device 1 was applicable to fractures of the humerus and femur, but was not used for fractures of the tibia because the ILN extension would have interfered with the stifle. No gross loosening of the ILN/ESF extension connection to the ILN occurred. Device 2 was easily placed and used in the humerus, femur, and tibia. Device 2 allowed removal of the ILN interlock to one or both main fracture segments non-invasively. Clinically, both devices added stability compared with ILN repair alone. Both devices facilitated controlled destabilization of the fracture repair as healing progressed. Complications of pin tract infection, and premature hybrid bolt/ESF pin loosening resulting in premature ESF removal each occurred in 1 patient. Four of 28 hybrid ILN/ESF pins were grossly loose at 4- or 6-week postoperative recheck examinations. Outcomes were excellent (9), good (1), fair (1), and poor (1).

CONCLUSIONS

Inadequately stabilized ILN repair of fractures can be stabilized by use of either device, both of which also permit controlled destabilization of the repair during healing. Device 2 can be used when non-invasive removal of the ILN interlock is desired during healing.

CLINICAL RELEVANCE

These 2 devices should be considered as alternative methods for stabilization of inadequately stabilized ILN repairs in dogs and cats, or when controlled destabilization of an ILN fracture repair is desired.

摘要

目的

描述两种用于改善犬猫肱骨、胫骨和股骨交锁髓内钉(ILN)固定不充分的骨折修复稳定性的装置。

研究设计

前瞻性研究。

动物

12只客户拥有的犬猫。

方法

开发了两种用于进一步稳定骨干骨折固定不充分的ILN修复的装置。装置1是ILN的轴向延伸部分,通过短连接杆与传统I型外固定架(ESF)相连。装置2具有混合ILN螺栓/ESF销,用于锁定ILN并作为I型ESF的销。当根据可触及的骨折段移动、骨折部位ILN的髓腔填充不足或ILN以支撑模式使用而认为ILN修复的稳定性不足时,在初次手术时使用这些装置。通过复查检查、X线摄影和电话访谈获得结果。

结果

装置1适用于肱骨和股骨骨折,但未用于胫骨骨折,因为ILN延伸部分会干扰膝关节。ILN/ESF延伸部分与ILN的连接未出现明显松动。装置2易于放置并用于肱骨、股骨和胫骨。装置2允许无创地将ILN锁扣移除至一个或两个主要骨折段。临床上,与单纯ILN修复相比,两种装置都增加了稳定性。随着愈合进展,两种装置都有助于控制骨折修复的不稳定。1例患者发生了针道感染并发症,以及混合螺栓/ESF销过早松动导致ESF过早移除。在术后4周或6周的复查检查中,28根混合ILN/ESF销中有4根明显松动。结果为优(9例)、良(1例)、中(1例)和差(1例)。

结论

使用这两种装置中的任何一种都可以稳定固定不充分的骨折ILN修复,这两种装置还允许在愈合过程中控制修复的不稳定。当在愈合过程中需要无创移除ILN锁扣时,可以使用装置2。

临床意义

这两种装置应被视为稳定犬猫固定不充分的ILN修复或需要控制ILN骨折修复不稳定时的替代方法。

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