Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
J Orthop Trauma. 2018 Sep;32(9):e376-e380. doi: 10.1097/BOT.0000000000001239.
The use of percutaneous clamps is often a helpful tool to aid reduction and intramedullary nailing of distal tibial spiral diaphyseal fractures. However, the anterior and posterior neurovascular bundles are at risk without careful clamp placement. We describe our preferred technique of percutaneous clamp reduction for distal spiral tibial fractures with a distal posterolateral fracture spike, with care to protect the adjacent neurovascular structures. We also investigated the relationship between these neurovascular structures and the site of common percutaneous clamp placement. Preoperative computed tomography images of surgically managed patients who sustained this specific common fracture pattern (distal third spiral diaphyseal tibia fracture with a posterolateral fragment) were retrospectively reviewed. On computed tomography, we extrapolated the ideal virtual clamp site on the posterolateral fracture fragment to facilitate reduction. The average distance of this clamp position from the anterior neurovascular bundle was 14 mm (SD = 7.6), with a range of 6-32 mm. The average distance of the clamp site from the posterior neurovascular bundle was 19 mm (SD = 6.1), with a range of 11-30 mm. In 31% of patients, the distal fragment's apex extended anterior to the interosseous membrane, and in 69% of patients, the apex was posterior to the interosseous membrane. We also describe our preferred surgical technique with percutaneous clamping and tibial nailing, which involves sliding the posterolateral tine of the percutaneous clamp along the lateral tibial cortex to prevent neurovascular bundle injury.
经皮夹的使用通常是一种有助于辅助复位和髓内钉固定胫骨远端螺旋骨干骨折的有用工具。然而，如果不仔细放置夹钳，前、后神经血管束就会面临风险。我们描述了一种经皮夹复位治疗带有后外侧骨折刺的胫骨远端螺旋骨折的首选技术，特别注意保护相邻的神经血管结构。我们还研究了这些神经血管结构与常见经皮夹放置部位之间的关系。回顾性分析了接受这种特定常见骨折模式（胫骨远端三分之一螺旋骨干骨折伴后外侧骨块）手术治疗的患者的术前计算机断层扫描图像。在计算机断层扫描上，我们推断出后外侧骨折块上理想的虚拟夹钳位置，以方便复位。该夹钳位置距前神经血管束的平均距离为 14 毫米（标准差=7.6），范围为 6-32 毫米。夹钳位置距后神经血管束的平均距离为 19 毫米（标准差=6.1），范围为 11-30 毫米。在 31%的患者中，远端骨块的顶点向前延伸至骨间膜，在 69%的患者中，远端骨块的顶点位于骨间膜的后方。我们还描述了我们首选的经皮夹固定和胫骨钉固定的手术技术，该技术包括沿胫骨外侧皮质滑动经皮夹的后外侧齿，以防止神经血管束损伤。
