Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA.
J Orthop Trauma. 2013 Jul;27(7):367-72. doi: 10.1097/BOT.0b013e31828c2ad1.
To compare the efficacy of distal interlocking during intramedullary nailing using a freehand technique versus an electromagnetic field real-time system (EFRTS).
A prospective, randomized controlled trial.
Level I academic trauma center.
PATIENTS/PARTICIPANTS: Patients older than 18 years who sustained a femoral or tibial shaft fracture amenable to antegrade intramedullary nailing were prospectively enrolled between August 2010 and November 2011. Exclusion criteria included injuries requiring retrograde nailing and open wounds near the location of the distal interlocks (distal third of the femur, knee, or distal tibia).
Each patient had 2 distal interlocking screws placed: one using the freehand method and the other using EFRTS.
Techniques were compared on procedural time and number of interlocking screw misses. Two time points were measured: time 1 (time to find perfect circles/time from wand placement to drill initiation) and time 2 (drill initiation until completion of interlocking placement).
Twenty-four tibia and 24 femur fractures were studied. EFRTS proved faster at times 1 and 2 (P < 0.0001 and P < 0.0002) and total time (P < 0.0001). This difference was larger for junior residents, though reached statistical significance for senior residents. Senior residents were faster with the freehand technique compared with junior residents (P < 0.004), but the 2 were similar using EFRTS (P = 0.41). The number of misses was higher with free hand compared with EFRTS (P = 0.02).
These results suggest that EFRTS is faster than the traditional freehand technique and results in fewer screw misses.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
比较徒手技术与电磁场实时系统（EFRTS）在髓内钉远端锁定时的疗效。
前瞻性、随机对照试验。
一级学术创伤中心。
患者/参与者：2010 年 8 月至 2011 年 11 月期间，前瞻性纳入年龄大于 18 岁、股骨或胫骨骨干骨折适合顺行髓内钉固定的患者。排除标准包括需要逆行钉固定和靠近远端锁定部位（股骨远端三分之一、膝关节或胫骨远端）的开放性伤口。
每位患者均放置 2 枚远端锁定螺钉：一枚使用徒手方法，另一枚使用 EFRTS。
比较操作时间和锁定螺钉缺失数量。测量了两个时间点：时间 1（找到完美圆圈的时间/从 wand 放置到钻头启动的时间）和时间 2（钻头启动到完成锁定放置的时间）。
研究了 24 例胫骨和 24 例股骨骨折。EFRTS 在时间 1 和时间 2（P<0.0001 和 P<0.0002）和总时间（P<0.0001）上更快。对于初级住院医师来说，这种差异更大，但对于高级住院医师来说也具有统计学意义。高级住院医师使用徒手技术比初级住院医师更快（P<0.004），但使用 EFRTS 时则相似（P=0.41）。与 EFRTS 相比，徒手技术的错过率更高（P=0.02）。
这些结果表明，EFRTS 比传统的徒手技术更快，并且锁定螺钉的缺失率更低。
治疗 II 级。请参阅作者说明以获取完整的证据水平描述。
