【作者】 姚勇；

【Author】 Yao Yong;Department of Orthopaedics, Enshi Central Hospital;

【机构】 湖北省恩施州中心医院关节外科；

【摘要】 目的研制小腿双向牵引器,使胫骨干骨折闭合复位髓内钉固定简单易行,降低手术难度。方法术中膝关节半伸直位,在平腓骨小头前缘或股骨髁打入4.0-5.0mm斯氏针一枚,在跟骨或胫骨下端打入5.0-6.0mm斯氏针一枚,克氏针分别装入上下插销装置,通过调节双侧纵行撑开杆的调节螺母,调节骨折复位需要的牵引长度及侧方移位角度,调节插销装置的深度,调节骨折断端复位需要的旋转角度,调节满意,固定插销和克氏针,进行髓内钉植入手术。结果 20例患者术中骨折所需复位时间平均15分钟。骨折复位所需透视次数3次(2-4次)。双侧小腿长度差值低于0.5cm,小腿远端旋转角度低于5度。术后比较双侧胫骨干全长正位X线测量骨折断端内外翻角度低于3度。侧位X线测量骨折近端及远端胫骨干的力线,同法测量健侧胫骨干的力线,比较双侧形成的角度的偏差,显示骨折断端前后成角偏差低于3度;双下肢髌骨朝上,踝背伸90度,比较双侧足旋转角度来判断远端肢体旋转角度。患肢骨折复位均达到优。结论小腿双向牵引器牵引力量充足,术中调节便利,维持稳定,不妨碍透视,而且操作简单易行,大大降低了手术难度;能减少手术时间,减少X线透视次数,提高胫骨干骨折固定的优良率。更多还原

【Abstract】 Objective To develop a bi-directional tractor for tibia and fibula shaft fracture, which can make closed reduction and intramedullary nail fixation simple and easy,and reduce the difficulty of operation. Methods During the operation, a 4.0-5.0 mm Stern pin was inserted into the anterior edge of the capitulum of the fibula or the femoral condyle, a 5.0-6.0 mm Stern pin was inserted into the lower end of the calcaneus or tibia,and the Kirschner pin was inserted into the upper and lower pin devices respectively. The adjusting nuts of the supporting rod were adjusted by adjusting the lengths and lateral displacement angles required for fracture reduction, and the vertical supporting tube and adjusting device were rotated. The depth of the insertion device, adjusting the rotation angle needed for fracture reduction, adjusting satisfactorily, fixing the insertion pin and Kirschner wire, and performing intramedullary nail implantation. Results The reduction time of 20 patients with intraoperative fracture was 15 minutes. The number of fluoroscopy needed for fracture reduction was 3 times(2-4 times). The difference of leg length between the two sides was less than 0.5 cm, and the rotation angle of distal leg was less than 5 degrees. Postoperatively, the angle of inversion and valgus at the fracture end was less than 3 degrees measured by full-length orthogonal X-ray of bilateral tibial shaft.The force line of proximal and distal tibial shaft was measured by lateral X-ray, and the force line of healthy tibial shaft was measured by the same method. The deviation of the angle formed on both sides was compared. It showed that the angle formed before and after fracture was less than 3 degrees; The patella of both lower limbs is upward and the ankle extends 90 degrees. The rotation angle of the distal limbs is judged by comparing the rotation angles of both feet.The reduction of fracture of affected limbs was excellent.Conclusion The bi-directional tractor has abundant traction force, convenient adjustment and stability during operation, and does not hinder fluoroscopy. It is easy to operate and greatly reduces the difficulty of operation. It can reduce the operation time, reduce the number of X-ray fluoroscopy, and improve the excellent and good rate of tibial shaft fracture fixation.更多还原