Krettek C, Könemann B, Farouk O, Miclau T, Kromm A, Tscherne H
Trauma Department, Hannover Medical School, Germany.
J Orthop Trauma. 1998 Aug;12(6):373-8. doi: 10.1097/00005131-199808000-00001.
Recently, radiation-independent aiming devices for the tibia that compensate for insertion-related implant deformation have been developed, but the benefits of such systems have not been determined. This study prospectively evaluated the duration of the nailing procedure, the length of radiation time, and the accuracy of interlocking screw placement when using a radiation-independent distal aiming device (DAD) versus the freehand technique (FHT).
In an oblique cadaveric tibial fracture, a surgeon inexperienced in both techniques (DAD and FHT) performed statically locked intramedullary nailing.
For the DAD and the FHT, respectively, the total operation time was 25.4 +/- 11.3 (mean +/- standard deviation) versus 30.9 +/- 14.3 minutes (p = 0.029), the distal locking time was 16.7 +/- 8.6 versus 21.9 +/- 10.5 minutes (p = 0.004), the total fluoroscopy time was 9 +/- 5 versus 93 +/- 34 seconds (p < 0.0001), the distal locking fluoroscopy time was zero versus 88 +/- 33 seconds (p < 0.0001), and the screw wear was -0.7 +/- 5.2 versus 26.8 +/- 31.6 micrometers (p = 0.001). The failure rate was 1.6 percent (one of sixty screws) in both groups.
These results suggest that the DAD can eliminate the need for radiation during placement of distal interlocking screws.
近来，已研发出用于胫骨的与放射无关的瞄准装置，其可补偿与植入物插入相关的变形，但此类系统的益处尚未明确。本研究前瞻性地评估了使用与放射无关的远端瞄准装置（DAD）与徒手技术（FHT）时，髓内钉固定手术的持续时间、放射时间长度以及交锁螺钉置入的准确性。
在一具尸体胫骨斜形骨折模型上，由一位对两种技术（DAD和FHT）均无经验的外科医生进行静力交锁髓内钉固定。
对于DAD和FHT，总手术时间分别为25.4±11.3（均值±标准差）分钟与30.9±14.3分钟（p = 0.029），远端锁定时间分别为16.7±8.6分钟与21.9±10.5分钟（p = 0.004），总透视时间分别为9±5秒与93±34秒（p < 0.0001），远端锁定透视时间分别为零秒与88±33秒（p < 0.0001），螺钉磨损分别为-0.7±5.2微米与26.8±31.6微米（p = 0.001）。两组的失败率均为1.6%（60枚螺钉中有1枚）。
这些结果表明，DAD可消除远端交锁螺钉置入过程中对放射的需求。
