Wegmann Kilian, Burkhart Klaus Josef, Buhl Jörg, Gausepohl Thomas, Koebke Jürgen, Müller Lars Peter
Department for Orthopaedics and Traumatology, University of Clogne, Cologne, Germany.
Acta Orthop Belg. 2012 Dec;78(6):786-9.
In intramedullary tibial nailing, multi-planar locking makes stabilization of proximal and distal metaphyseal fractures possible. A known complication in intramedullary nailing of the tibia is iatrogenic injury to neuro-vascular structures caused by the insertion of locking screws. As shown in previous studies, the distal positioning of the nail is important, as it determines the course of the locking bolts. The goal of the present study was to display the consequences of posterior nail malpositioning with respect to the safety of the distal medio-lateral locking screws and the available options. Human cadaveric legs were plastinated according to the sequential plastination technique after intramedullary nailing of the tibia and were then cut transversely. The tibial nails were placed centrally or posteriorly. Macroscopic analysis showed a distinct drawback of posterior nail positioning, with diminished options for the placement of the locking screws and thereby a risk of damaging the anterior and posterior neuro-vascular bundles by distal medio-lateral locking screws.
在胫骨髓内钉固定术中，多平面锁定使近端和远端干骺端骨折的稳定成为可能。胫骨骨髓内钉固定术的一个已知并发症是锁定螺钉插入导致的神经血管结构医源性损伤。如先前研究所示，髓内钉的远端定位很重要，因为它决定了锁定螺栓的走向。本研究的目的是展示髓内钉后位错置对远端内外侧锁定螺钉安全性的影响以及可用的选择。在胫骨进行髓内钉固定术后，根据连续塑化技术对人体尸体下肢进行塑化，然后横向切开。将胫骨髓内钉置于中央或后方。宏观分析显示，髓内钉后位错置有明显缺点，锁定螺钉的放置选择减少，从而存在远端内外侧锁定螺钉损伤前后神经血管束的风险。
