股骨远端交锁螺钉置入：徒手操作与电磁辅助技术（SureShot）

Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot).

作者信息

Maqungo Sithombo, Horn Anria, Bernstein Brian, Keel Marius, Roche Stephen

机构信息

*Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; †Cape Orthopaedic Trauma Group, Vincent Pallotti Hospital, Cape Town, South Africa; and ‡Department of Orthopaedic and Trauma Surgery, University Hospital Bern, Inselspital, Bern, Switzerland.

出版信息

J Orthop Trauma. 2014 Dec;28(12):e281-3. doi: 10.1097/BOT.0000000000000125.

DOI:10.1097/BOT.0000000000000125

PMID:24714403

Abstract

OBJECTIVES

To compare the free-hand (FH) technique of placing interlocking screws to a commercially available electromagnetic (EM) targeting system in terms of operating time, radiation dose, and accuracy of screw placement.

METHODS

Between September 2011 and July 2012, we prospectively randomized 100 consecutive femur shaft fractures in 99 patients requiring intramedullary nails to either FH using fluoroscopy (n = 43) or EM targeting (n = 38; Sureshot).

SETTING

Single Level 1 University Hospital Trauma Center.

MAIN OUTCOME MEASUREMENTS

The 2 groups were assessed for distal locking with respect to time, radiation, and accuracy.

RESULTS

Eight-one fractures had data accurately recorded (38 EM/43 FH). The average total operative time was 50 minutes (range, 25-88 minutes; SD, 13.9 minutes) for the FH group and 57 minutes (range, 40-103 minutes; SD, 16.12 minutes) for the EM group. The average time for distal locking was 10 minutes (range, 4-16 minutes; SD, 3.56 minutes) with FH and 11 minutes (range, 6-28 minutes; SD, 10.24 minutes) with EM. Average radiation dose for distal locking was significantly less (P < 0.0001) for EM at 230.54 μGy (range, 51-660 μGy; SD, 0.17 μGy) compared with 690.27 μGy (range, 200-2310 μGy; SD, 0.52 μGy) for FH. There were 2 misplaced drill bits in FH and 3 in EM. This was not statistically significant (P = 0.888).

CONCLUSIONS

The electromagnetic targeting device (Sureshot) significantly reduced radiation exposure during placement of distal interlocking screws, without sacrificing operative time, and was equivalent in accuracy when compared with the FH technique.

LEVEL OF EVIDENCE

Therapeutic level II.

摘要

目的

比较徒手（FH）置入交锁螺钉技术与市售电磁（EM）靶向系统在手术时间、辐射剂量和螺钉置入准确性方面的差异。

方法

在2011年9月至2012年7月期间，我们将99例需要髓内钉治疗的股骨干骨折患者的100例连续骨折前瞻性随机分为使用透视的FH组（n = 43）或EM靶向组（n = 38；Sureshot）。

地点

一级大学医院创伤中心。

主要观察指标

评估两组在远端锁定方面的时间、辐射和准确性。

结果

81例骨折的数据记录准确（38例EM/43例FH）。FH组平均总手术时间为50分钟（范围25 - 88分钟；标准差13.9分钟），EM组为57分钟（范围40 - 103分钟；标准差16.12分钟）。FH组远端锁定平均时间为10分钟（范围4 - 16分钟；标准差3.56分钟），EM组为11分钟（范围6 - 28分钟；标准差10.24分钟）。EM组远端锁定的平均辐射剂量显著更低（P < 0.0001），为230.54 μGy（范围51 - 660 μGy；标准差0.17 μGy），而FH组为690.27 μGy（范围200 - 2310 μGy；标准差0.52 μGy）。FH组有2个钻头位置错误，EM组有3个。这在统计学上无显著差异（P = 0.888）。