Rueger J M, Rücker A H, Hoffmann M
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland,
Unfallchirurg. 2015 Apr;118(4):302-10. doi: 10.1007/s00113-014-2669-1.
Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking.
闭合性胫骨干骨折属于髓内钉固定的范畴。随着新型髓内钉设计和技术的引入，即使是小的、移位的远端骨折块也能实现解剖复位并安全固定。徒手技术中的远端锁定问题仍未得到解决或仅在一定程度上得到控制，这一操作仍可能困难且会导致大量辐射暴露，此外，在胫骨近端骨折线也穿过干骺端的干骺端胫骨骨折或胫骨节段性骨折中，如何控制非常短的近端胫骨骨折块也是个问题。通过采用髌上入路，即在髌骨近端做皮肤切口，从膝关节内与标准髌下入路相同的部位进入胫骨骨内，然后在膝关节半伸直位（即膝关节仅屈曲10 - 20°）进行胫骨髓内钉固定，可避免术中短的近端骨折块发生移位。半伸直位胫骨髓内钉固定的主要适应证为孤立性胫骨干骨折中的短骨干骨折块、近端骨折线位于干骺端的节段性骨折以及髌下软组织受损的患者。使用SureShot®电磁导航系统可产生可靠且可重复的结果，减少手术时间，并且远端锁定操作无需辐射。
