Höntzsch D, Blauth M, Attal R
BG Unfallklinik und Universitätsklinik, Tübingen, Deutschland.
Oper Orthop Traumatol. 2011 Dec;23(5):387-96. doi: 10.1007/s00064-011-0048-4.
Greater stability in intramedullary osteosynthesis using angle-stable fixation with intramedullary nails and proximal locking screws. A novel screw-and-sleeve system (ASLS®, Synthes GmbH, Oberdorf, Switzerland) is applied using normal cannulated nails. Decisions can be made intraoperatively.
This technology widens the range of indications for intramedullary nailing: The smaller and less stable the fragment requiring fixation, the greater the indication for angular stable fixation of the proximal and/or distal fragment. Femoral, tibial and humeral fractures, intramedullary osteosynthesis in osteoporotic bone and ante- and retrograde nailing. Particularly in the case of retrograde nailing, sustained prevention of nail toggling is achieved.
None.
Drill with the first drill bit, which has the same core diameter as the screw shaft. Drill the cortex to the external diameter of the sleeve. Place the sleeve on the tip of the screw. The screw-sleeve combination is then advanced through the larger near hole until the sleeve-covered screw tip sits in the locking hole of the intramedullary fixation nail. Advance the screw. As the screw diameter becomes larger, the sleeve expands resulting in an angular stable locking effect. The screw is then advanced until the head of the screw sits on the exposed surface of the cortex. The hole is filled with the expanded part of the screw shaft beneath the screw head. The necessary 1-3 turns are cut by the self-tapping flute on the screw.
According to experience to date, this form of angle-stable fixation enables earlier and/or greater partial mobilization or earlier full mobilization. In all other respects, the guidelines for aftercare in intramedullary nailing apply.
A multi-center pilot study has shown the technique to be reproducible and simple. There have been no complications using this technique to date. Biomechanical laboratory studies have demonstrated that stability with respect to axial and torsional loading is statically and dynamically higher than with conventional nailing. Device failure occurs later. Further applications as well as results of a prospective randomised study currently under way will show how great the clinical advantages ultimately prove to be.
使用带角度稳定固定的髓内钉和近端锁定螺钉，实现髓内骨固定的更高稳定性。采用一种新型的螺钉 - 套筒系统（ASLS®，Synthes GmbH，瑞士奥伯多夫），搭配普通空心钉使用。术中即可做出决策。
该技术拓宽了髓内钉固定的适应症范围：需要固定的骨折块越小且越不稳定，近端和/或远端骨折块角度稳定固定的适应症就越强。适用于股骨、胫骨和肱骨骨折、骨质疏松性骨的髓内固定以及顺行和逆行髓内钉固定。特别是在逆行髓内钉固定的情况下，可持续防止髓内钉摆动。
无。
使用与螺钉杆芯直径相同的第一根钻头钻孔。将皮质骨钻至套筒外径。将套筒置于螺钉尖端。然后将螺钉 - 套筒组合推进较大的近端孔，直到套筒覆盖的螺钉尖端位于髓内固定钉的锁定孔中。推进螺钉。随着螺钉直径增大，套筒扩张，从而产生角度稳定的锁定效果。然后继续推进螺钉，直到螺钉头部位于皮质骨暴露表面。孔被螺钉头部下方的螺钉杆扩张部分填满。螺钉上的自攻凹槽会切削所需的1 - 3圈螺纹。
根据目前的经验，这种角度稳定固定形式能够实现更早和/或更大程度的部分活动或更早的完全活动。在所有其他方面，髓内钉固定术后护理指南适用。
一项多中心试点研究表明该技术具有可重复性且操作简单。迄今为止，使用该技术未出现并发症。生物力学实验室研究表明，在轴向和扭转负荷方面，其稳定性在静态和动态上均高于传统髓内钉固定。器械失效出现得更晚。进一步的应用以及正在进行的前瞻性随机研究结果将最终表明其临床优势究竟有多大。
