Mehta Nisarg, Selvaratnam Veenesh, Giotakis Nikolaos, Narayan Badri
Core Surgical Trainee (CT2) in Trauma & Orthopaedics Surgery, Royal Liverpool & Broadgreen Teaching Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
Core Surgical Trainee (CT2) in Trauma & Orthopaedics Surgery, Royal Liverpool & Broadgreen Teaching Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
Injury. 2017 Feb;48(2):506-510. doi: 10.1016/j.injury.2016.12.002. Epub 2016 Dec 10.
Traditional methods of nailing distal tibial fractures have an unacceptable risk of mal-alignment due to difficulty in obtaining and maintaining reduction intra-operatively. Methods to obtain and maintain reduction when nailing these fractures, and therefore reducing the risk of Mal-alignment include modified external fixators, distractors and commercial reduction tools. Semi-extended intramedullary nailing of distal tibial fractures via a supra-patellar approach is now being used more commonly. The aim of this study was to assess whether a commercial reduction device (Staffordshire Orthopaedic Reduction Machine - STORM, Intelligent Orthopaedics, Stafffordshire, UK) is necessary to reduce the risk of mal-alignment in patients undergoing semi-extended nailing for distal tibial fractures.
A case-control study was conducted in 20 patients who had STORM-assisted reduction of distal tibial fractures prior to intramedullary nailing and 20 controls without STORM. The control group was matched for age, sex, fracture type (AO/OTA), ASA and gender. All patients had an intramedullary nail (IMN) using the semi-extended system. Primary outcome measures were coronal and sagittal mal-alignment. Secondary outcome measure was unplanned return to theatre for complications and problems with fracture healing.
There was no difference in post-operative mal-alignment in both groups. There was no significant difference in time to union in both groups Both groups had equal number of patients requiring unplanned return to theatre. The STORM group was associated with a significantly increased operative time [p=0.007, 130.3min (SD 49.4) STORM vs 95.6 mins (SD 22.9) Control].
Intraoperative use of STORM significantly increases operative time with no difference in outcome. The superior orthogonal views and manual control obtained during semi-extended nailing via a supra-patellar approach obviate the need for additional methods: of intraoperative reduction for this fracture group.
由于术中难以实现和维持胫骨远端骨折的复位，传统的髓内钉固定方法存在不可接受的对位不良风险。在髓内钉固定这些骨折时，用于实现和维持复位从而降低对位不良风险的方法包括改良外固定器、撑开器和商用复位工具。目前，经髌上入路的胫骨远端骨折半延长髓内钉固定术应用更为普遍。本研究的目的是评估对于接受胫骨远端骨折半延长髓内钉固定术的患者，使用一种商用复位装置（英国斯塔福德郡智能矫形公司的斯塔福德郡矫形复位器 - STORM）是否有必要降低对位不良的风险。
进行了一项病例对照研究，纳入20例在髓内钉固定前接受STORM辅助复位的胫骨远端骨折患者和20例未使用STORM的对照组患者。对照组在年龄、性别、骨折类型（AO/OTA）、美国麻醉医师协会分级（ASA）和性别方面进行了匹配。所有患者均采用半延长系统置入髓内钉。主要观察指标为冠状面和矢状面对位不良。次要观察指标为因并发症和骨折愈合问题而计划外返回手术室的情况。
两组术后对位不良情况无差异。两组骨折愈合时间无显著差异。两组中需要计划外返回手术室的患者数量相等。STORM组的手术时间显著延长[p = 0.007，STORM组为130.3分钟（标准差49.4），对照组为95.6分钟（标准差22.9）]。
术中使用STORM显著延长了手术时间，但结果并无差异。经髌上入路的半延长髓内钉固定术中获得的优质正交视图和手动控制无需额外的术中复位方法用于该骨折组。
