Carr James B, Williams Daniel, Richards Mike
Department of Orthopedics, United States Army, Fort Gordon, Augusta, Georgia, USA.
Orthopedics. 2009 Oct;32(10). doi: 10.3928/01477447-20090818-05.
In closed intramedullary nailing of the femur in the lateral decubitus position without the use of a fracture table, access to the proximal femur is enhanced as compared to supine nailing, especially in large patients. The hip is typically flexed during the nailing, which allows the nail to be placed posterior to the gluteus medius, thus minimizing abductor damage. The deforming forces of flexion and abduction in proximal fracture patterns can be readily overcome by this technique. Proper rotation of the leg can be assessed clinically or with the use of a femoral neck anteversion guide wire. Fluoroscopic visualization of the proximal femur is excellent, including the femoral head, thus facilitating reconstruction nailing.
在不使用骨折手术台的侧卧位下行股骨闭合髓内钉固定时，与仰卧位钉固定相比，进入股骨近端的操作更便利，尤其是对于体型较大的患者。在钉固定过程中，髋关节通常处于屈曲位，这使得髓内钉能够置于臀中肌后方，从而将外展肌损伤降至最低。该技术能够轻松克服近端骨折类型中屈曲和外展的变形力。可以通过临床评估或使用股骨颈前倾角导丝来正确评估下肢的旋转情况。对股骨近端进行荧光透视成像效果极佳，包括股骨头，从而便于进行重建钉固定。
