Anastopoulos George, Ntagiopoulos Panagiotis G, Chissas Dionisios, Papaeliou Athanasios, Asimakopoulos Antonios
2nd Department of Orthopaedic and Trauma Surgery, G. Gennimatas General Hospital of Athens, 56-60, Koniari Street, 115 21 Athens, Greece.
Clin Orthop Relat Res. 2008 Jan;466(1):216-20. doi: 10.1007/s11999-007-0036-z. Epub 2008 Jan 3.
The indications for intramedullary nailing have expanded to include most tibial shaft fractures. Nail design has improved since their first introduction, but distal locking remains a difficult part of the procedure, resulting in radiation exposure to the patient and the surgeon and increased operation time. To address these issues, we describe an alternative surgical technique using a newly designed distal targeting device that consists of a proximally mounted aiming arm, and we report the preliminary data from its use in all tibial shaft fractures amenable to surgery for a 2-year period. Sixty-three tibial shaft fractures were treated with this method. The mean duration of the distal locking was 6.5 minutes, and in all successful cases, radiation exposure for distal locking was two shots (one shot before targeting and another for the confirmation of proper screw insertion). Radiation exposure was on average 0.85 seconds (range, 0.4-1.2 seconds) and 1.4 mGy (range, 0.8-1.9 mGy). There were no major intraoperative complications related to the technique. The method has certain advantages and can reduce radiation exposure and operation time. Nonetheless, familiarity with the instrumentation is a prerequisite for accurate distal locking.
Level IV Therapeutic study.
髓内钉固定的适应证已扩大到包括大多数胫骨干骨折。自首次引入以来，髓内钉的设计已有改进，但远端锁定仍是该手术的难点，会导致患者和外科医生受到辐射暴露，并延长手术时间。为解决这些问题，我们描述了一种使用新设计的远端瞄准装置的替代手术技术，该装置由近端安装的瞄准臂组成，并报告了其在2年期间用于所有适合手术的胫骨干骨折的初步数据。采用该方法治疗了63例胫骨干骨折。远端锁定的平均持续时间为6.5分钟，在所有成功的病例中，远端锁定的辐射暴露为两次照射（一次在瞄准前，另一次用于确认螺钉正确插入）。辐射暴露平均为0.85秒（范围为0.4 - 1.2秒）和1.4毫戈瑞（范围为0.8 - 1.9毫戈瑞）。未出现与该技术相关的重大术中并发症。该方法具有一定优势，可减少辐射暴露和手术时间。尽管如此，熟悉该器械是准确进行远端锁定的前提条件。
IV级治疗性研究。
