Strecker W, Hoellen I, Keppler P, Suger G, Kinzl L
Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie der Universität, Ulm.
Unfallchirurg. 1997 Jan;100(1):29-38. doi: 10.1007/s001130050092.
Intraoperative control of torsion is delicate in intramedullary nailing of femur and tibia fractures. Post-traumatic torsional deformities cause clinical problems if the rotational 0-position, according to the neutral-0-method, cannot be attained or exceeded. The necessary precondition for every indication and planning of corrective osteotomies is conscientious analysis of the geometry of the lower extremities by clinical means, radiography and computed tomography. Operative procedures and techniques of corrective osteotomies in case of torsional deformities after intramedullary nailing are presented. Preoperatively, the intraindividual torsional differences in 15 patients with maltorsions of the femur were 33 degrees (-37/+50) and in 7 patients with maltorsions of the tibia 23 degrees (-21/+29). Positive signs indicate external and negative signs of internal maltorsions. Postoperatively, the intraindividual torsional differences were 6 degrees (-3/+14) in the femora and 7 degrees (+3/+12) in the tibiae. Therefore, the physiological torsional tolerance of 15 degrees was respected in all 22 patients. Additionally, limb lengthening was realized in 4 patients with shortening after intramedullary nailing of the femur. In 3 patients a one-step procedures with interposition of allogeneic cancellous bone in the osteotomy gap was performed and in one patient continuous callus distraction by external fixation.
在股骨和胫骨骨折的髓内钉固定术中，扭转的术中控制较为精细。如果根据中立-0法无法达到或超过旋转0位，创伤后扭转畸形会引发临床问题。对每一例矫正截骨术的指征和规划而言，必要的前提是通过临床检查、X线摄影和计算机断层扫描对下肢几何结构进行认真分析。本文介绍了髓内钉固定术后出现扭转畸形时矫正截骨术的手术步骤和技术。术前，15例股骨扭转不良患者的个体内扭转差异为33度（-37/+50），7例胫骨扭转不良患者为23度（-21/+29）。正值表示外扭转，负值表示内扭转。术后，股骨的个体内扭转差异为6度（-3/+14），胫骨为7度（+3/+12）。因此，所有22例患者均遵循了15度的生理扭转耐受度。此外，4例股骨髓内钉固定术后出现短缩的患者实现了肢体延长。3例患者采用在截骨间隙植入同种异体松质骨的一步法，1例患者采用外固定进行连续骨痂牵张。
