Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Orthop Traumatol Surg Res. 2013 Nov;99(7):799-804. doi: 10.1016/j.otsr.2013.06.006. Epub 2013 Oct 4.
Intramedullary nail distal locking screws make it possible to control length and rotation but include an increased risk of radiation exposure. A distal targeting device was recently developed for long Gamma(®) nails (Stryker(®)). The aim of this practical observational study was to evaluate the reliability of this system. Our hypothesis was that the targeting device would be systematically used without conversion or complications.
All of the long Gamma(®) nails implanted between November 2011 and October 2012 were recorded: 91 nails (59W/32M, mean age 73.5years old) for 68 traumatic fractures, 14 preventive nailings and nine pathological fractures. A junior surgeon performed the procedure in 45 cases and a senior in 46 cases. The number of times the device was used, the difficulties and complications encountered, the duration of fluoroscopy and the dose of radiation were noted. Risk factors were looked for.
The targeting device was used 79 times (the surgeon chose not to use it 11 times, and it was not available in one case). There was a measurement error in one case, therefore 78 nails could be evaluated. Three wrong positions of the distal locking screw occurred. No statistically significant risk factors were identified. Distal locking screw corresponded to 18% of the entire procedure at a radiation dose of 7.44% (this was higher with titanium nails and pathological fractures). Total fluoroscopy time was longer with junior than with senior surgeons but the dose and duration for distal locking were not different.
The hypothesis was not confirmed. The device was not systematically used and the risk of complications was not null. No risk factors were identified. The distal locking screw is a difficult step but the use of the targeting device can limit the dose of radiation. This device is effective and allows young surgeons to perform distal locking without increasing the dose of radiation compared to senior surgeons.
Level IV, cohort study, observational prospective follow-up.
髓内钉远端锁定螺钉可以控制长度和旋转，但会增加辐射暴露的风险。最近开发了一种用于长 Gamma（®）钉（Stryker（®））的远端瞄准装置。本研究的目的是评估该系统的可靠性。我们的假设是该瞄准装置将被系统地使用，而无需转换或出现并发症。
记录了 2011 年 11 月至 2012 年 10 月期间植入的所有长 Gamma（®）钉：68 例创伤性骨折（59 例女性/32 例男性，平均年龄 73.5 岁）、14 例预防性固定和 9 例病理性骨折。45 例由初级外科医生进行手术，46 例由高级外科医生进行手术。记录了使用该装置的次数、遇到的困难和并发症、透视时间和辐射剂量。寻找危险因素。
该装置使用了 79 次（外科医生选择不使用 11 次，一次无法使用）。有 1 例测量误差，因此仅评估了 78 颗钉。3 颗远端锁定螺钉的位置错误。未发现有统计学意义的危险因素。与钛钉和病理性骨折相比，远端锁定螺钉占整个手术过程的 18%，辐射剂量为 7.44%。与高级外科医生相比，初级外科医生的总透视时间较长，但远端锁定的剂量和时间没有差异。
假设未得到证实。该装置未被系统使用，且并发症风险并非为零。未发现危险因素。远端锁定螺钉是一个困难的步骤，但使用瞄准装置可以限制辐射剂量。与高级外科医生相比，该装置可有效降低年轻外科医生的辐射剂量，同时使他们能够进行远端锁定。
IV 级，队列研究，前瞻性观察随访。
