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髓内皮质碎片在胫骨钉固定术中:推它,取出它,还是忽略它?

Intramedullary cortical fragment in tibial nailing: push it, remove it or ignore it?

机构信息

U.O. Ortopedia e Traumatologia, Ospedale M. Bufalini, Cesena (FC).

.

出版信息

Acta Biomed. 2021 Jul 26;92(S3):e2021012. doi: 10.23750/abm.v92iS3.11714.

DOI:10.23750/abm.v92iS3.11714
PMID:34313669
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8420818/
Abstract

Intramedullary nailing of long bones is a safe procedure, with excellent long-term results. Even in apparently simple fractures, many complications may arise. Incarceration of a cortical fragment in the medullary canal is a fearsome situation, which may lead to severe complications and, consequently, poor outcomes. The surgeon should be aware of this risk and, after careful analysis of the pre-operative imaging, must remove or, at least, disengage the fragment from the medullary canal.

摘要

髓内钉固定长骨是一种安全的手术,具有极好的长期效果。即使在看似简单的骨折中,也可能出现许多并发症。骨皮质碎片嵌顿在髓腔中是一种可怕的情况,可能导致严重的并发症,并因此导致不良的结果。外科医生应该意识到这种风险,并且在仔细分析术前影像学检查后,必须将碎片从髓腔中取出或至少使其与髓腔脱离。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/93bc91df0f59/ACTA-92-12-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/9fd2a61b143b/ACTA-92-12-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/639a5985f674/ACTA-92-12-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/172df9114044/ACTA-92-12-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/c0d6b6c678c6/ACTA-92-12-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/93bc91df0f59/ACTA-92-12-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/9fd2a61b143b/ACTA-92-12-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/639a5985f674/ACTA-92-12-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/172df9114044/ACTA-92-12-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/c0d6b6c678c6/ACTA-92-12-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4beb/8420818/93bc91df0f59/ACTA-92-12-g005.jpg

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本文引用的文献

1
Incarcerated Cortical Fragments in Intramedullary Nailing.髓内钉固定术中的嵌顿皮质骨碎片
Orthopedics. 2016 May 1;39(3):e582-6. doi: 10.3928/01477447-20160414-04. Epub 2016 Apr 18.
2
Intramedullary cortical fragments: Recognition and techniques to permit safe nailing.髓内皮质碎片:识别及安全髓内钉固定技术
Injury. 2015 Dec;46(12):2502-6. doi: 10.1016/j.injury.2015.08.019. Epub 2015 Aug 19.
3
Inadvertent advancement of guide wire across the knee caused by incarcerated bone fragment at the nail tip during femoral nailing.
股骨钉固定时,钉尖处嵌顿的骨碎片导致导丝意外穿过膝关节。
Chin J Traumatol. 2014 Apr 1;17(2):118-20.
4
Intramedullary bone fragment obstructing passage of reaming guide wire with iatrogenic fractured tibia.髓内骨碎片阻碍扩髓导丝通过并伴有医源性胫骨骨折。
Orthopedics. 2010 Feb;33(2):119-21. doi: 10.3928/01477447-20100104-24.
5
Unusual complication following intramedullary nailing of tibia: a case report.胫骨髓内钉固定术后的罕见并发症:一例报告
Cases J. 2009 Sep 14;2:7343. doi: 10.4076/1757-1626-2-7343.
6
Intramedullary bone fragment preventing passage of reaming guide wire.髓内骨碎片阻碍扩髓导丝通过。
Am J Orthop (Belle Mead NJ). 2007 Sep;36(9):492-3.
7
Technical problems caused by comminuted cortical free fragments during intramedullary rodding: case reports.髓内棒插入过程中粉碎性皮质游离碎骨片引起的技术问题:病例报告
J Trauma. 1994 May;36(5):749-51. doi: 10.1097/00005373-199405000-00029.