Michalowski Anna K, Puzzitiello Richard N, Ryan Scott P
Department of Orthopaedics, Tufts Medical Center, Boston, MA, USA.
J Clin Orthop Trauma. 2023 Jul 4;42:102208. doi: 10.1016/j.jcot.2023.102208. eCollection 2023 Jul.
Lag screw positioning can be difficult to discern intraoperatively on lateral fluoroscopic imaging during intramedullary fixation of proximal femur fractures in some nailing systems due to the drill guide handle obstructing the view. We have described a method of obtaining non-obstructed lateral-oblique "peek" views that reliably assist in obtaining adequate tip-apex distance (TAD) measurements when using intramedullary fixation for these fractures. The purpose of this study was (1) to describe an intraoperative radiographic technique to obtain non-obscured views for appropriate center-center placement of the lag screw(s) within the femoral head during jig-aided cephalomedullary nailing of peritrochanteric hip fractures and (2) to present a case series detailing the radiographic results using this technique. This clinical series of sixty-five patients with intertrochanteric or subtrochanteric proximal femur fractures stabilized with a cephalomedullary nail had an average TAD of 15.1 ± 3.3mm (range: 9.4mm-26.2mm). This suggests that our technical trick of obtaining "peek" radiographs intraoperatively may aid in a precise lag-screw placement.
在某些髓内钉系统中，由于钻导向手柄遮挡视野，在股骨近端骨折的髓内固定术中，术中在侧位透视成像上很难辨别拉力螺钉的位置。我们描述了一种获得无遮挡的侧斜位“窥视”视图的方法，当对这些骨折使用髓内固定时，该方法能可靠地帮助获得足够的尖顶距（TAD）测量值。本研究的目的是：（1）描述一种术中放射成像技术，以在使用夹具辅助的股骨近端髓内钉固定术治疗转子周围髋部骨折时，获得无遮挡的视图，以便在股骨头内适当的中心对中心放置拉力螺钉；（2）展示一个病例系列，详细说明使用该技术的放射成像结果。这一包含65例使用股骨近端髓内钉固定稳定的转子间或转子下股骨近端骨折患者的临床系列，其平均尖顶距为15.1±3.3毫米（范围：9.4毫米至26.2毫米）。这表明我们术中获得“窥视”X线片的技术技巧可能有助于精确放置拉力螺钉。
