Yu Shuisheng, Xu Xinzhong, Pandey Nitesh Raj, Zhao Yao, Jing Juehua
Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China.
Department of Orthopaedics, B&B Hospital, Guwarko, Lalitpur, Kathmandu, Nepal.
Medicine (Baltimore). 2019 Apr;98(15):e15163. doi: 10.1097/MD.0000000000015163.
We present a safe percutaneous technique for the placement of Kirschner wires into the femoral head to assist in the reduction of irreducible femoral neck fractures using ultrasound to identify the vascular and nervous structures about the hip.From January 2011 to June 2014, a total of 36 patients (25 males and 11 females) were enrolled in this study. Patients were placed on a fracture reduction table for limb traction. After 3 unsuccessful reductions with limb traction, ultrasound-guided localization of the patient's femoral artery, vein, and nerve at the hip was performed. These structures were marked on the overlying skin and then Kirschner wires were inserted into the femoral head avoiding these marked structures. After the surgery, the Kirschner wire insertions were routinely reviewed by ultrasound, the hip fracture reduction and the femoral nerve sensorimotor function were routinely examined as well.All 36 patients with an irreducible variant of a femoral neck fracture showed anatomic reduction under C-arm fluoroscopy using ultrasound to avoid K wire injury to the femoral vascular structures and nerve. No major vascular injury during operation. In post-surgical ultrasound examination, local hematoma formation was not evident. There was normal function of the femoral nerve. On follow-up, there were no infections, wound problems, recurrence of fracture displacement, laxity, or implant breakage.Preoperative ultrasonic localization of the femoral artery, vein, and femoral nerve safely allowed. Kirschner wire placement under C-arm fluoroscopy into the femoral head to assist in fracture reduction. This assisted reduction method for irreducible femoral neck fractures had a number of advantages, including closed anatomic reduction with minimal attempts, used simple equipment, and avoided further destruction of the blood supply to the femoral head.
我们介绍一种安全的经皮技术，用于将克氏针置入股骨头，以辅助复位难复性股骨颈骨折，该技术利用超声识别髋关节周围的血管和神经结构。2011年1月至2014年6月，共有36例患者（25例男性和11例女性）纳入本研究。患者被置于骨折复位台上进行肢体牵引。在肢体牵引3次复位失败后，对患者髋关节处的股动脉、静脉和神经进行超声引导定位。在覆盖的皮肤上标记这些结构，然后将克氏针插入股骨头，避开这些标记结构。手术后，通过超声对克氏针的插入情况进行常规检查，同时对髋关节骨折复位情况和股神经感觉运动功能进行常规检查。所有36例难复性股骨颈骨折患者在C形臂透视下均实现了解剖复位，通过超声避免了克氏针对股血管结构和神经的损伤。术中无重大血管损伤。术后超声检查显示无明显局部血肿形成。股神经功能正常。随访期间，无感染、伤口问题、骨折移位复发、松弛或植入物断裂。术前对股动脉、静脉和股神经进行超声定位可安全地在C形臂透视下将克氏针置入股骨头以辅助骨折复位。这种用于难复性股骨颈骨折的辅助复位方法具有许多优点，包括以最少的尝试实现闭合解剖复位、使用简单设备以及避免进一步破坏股骨头的血供。
