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    磁力導航交鎖髓內釘在股骨干骨折中的應用
    關鍵字:應用,骨干,導航,骨折,定位,造造,治療,園園,棗棗,鎖定, 發布時間:2011-08-20

    中國醫學創新搖圓園員園年員員月搖第苑卷第猿員期搖醞藻鑿蚤糟葬造隕灶灶燥增葬賊蚤燥灶燥棗悅澡蚤灶葬,暈燥增藻皂遭藻則援圓園員園,災燥造郾苑暈燥郾猿員 量造成影響。而在各種慢性疾病的發生、發展和轉歸過程 中,心理因素往往起著不可忽視的作用,這些過大的精神壓 力往往會增加對學科帶頭人身體的損害。 參考文獻 [員]楊新偉,金泰廙,王治明,等援科學研究人員職業緊張及影響因素 分析援中國行為醫學科學,圓園園緣,員源(員員):員園猿員原員園猿猿援搖 [圓]宣勇,黃揚杰援學科帶頭人的能力與學科組織成長原基于國家重 點學科的問卷調查分析援高等工程教育研究,圓園園苑,員怨(遠): 苑圓原苑苑援 [猿]孔繁正援淺談高職院校的專業帶頭人減少援廣東農工商職業技術 學院學報,圓園園遠,圓圓(猿):源員原源猿援 [源]張碧昌,鄧冰,李杰,等援中年知識分子生存質量及其影響因素研 究援現代預防醫學,圓園園緣,猿圓(員園):員圓苑愿原員圓愿園,員猿園園援 (收稿日期:圓園員園原園愿原圓苑) (本文編輯:張雄杰) 磁力導航交鎖髓內釘在股骨干骨折中的應用 陳小強搖謝洋搖李健搖陸斌 搖搖作者單位:圓源猿園園園安徽省馬鞍山市人民醫院 通訊作者:陳小強 【摘要】搖目的搖評價磁力導航交鎖髓內釘治療股骨干骨折的療效及其與普通交鎖髓內釘療效比較。方法搖將 源圓例股骨干骨折患者分為兩組:粵組員愿例,使用磁力導航交鎖髓內釘治療。月組圓源例,使用普通交鎖髓內釘治療。 記錄兩組遠端圓枚鎖釘鎖定成功時間,一次性鎖定成功率,骨折愈合時間,根據馬元璋等評分標準評價兩組療效。結 果搖粵組遠端圓枚鎖釘鎖定成功時間平均(苑郾苑依圓郾園)皂蚤灶,月組(員猿郾緣依圓郾圓)皂蚤灶,兩組差異有統計學意義(孕約 園郾園緣);粵組一次性鎖定成功率怨源郾源豫,月組苑緣郾園豫,兩組差異有統計學意義(孕約園郾園緣);粵組骨折愈合時間平均 員遠郾苑依員郾遠周,月組員遠郾緣依員郾愿周,兩組差異無統計學意義(孕躍園郾園緣);療效優良率:粵組愿愿郾怨豫,月組愿苑郾緣豫,兩組差 異無統計學意義(孕躍園郾園緣)。結論搖磁力導航交鎖髓內釘治療股骨干骨折療效滿意。相比普通交鎖髓內釘有定位 準確,手術時間短,創傷小的優勢。 【關鍵詞】搖磁力導航;搖交鎖髓內釘;搖股骨干骨折 醞葬早灶藻賊蚤糟灶葬增蚤早葬賊蚤燥灶蚤灶賊藻則造燥糟噪蚤灶早蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造蚤灶賊澡藻賊則藻葬賊皂藻灶賊燥棗棗藻皂燥則葬造澤澡葬棗賊棗則葬糟賊怎則藻搖悅勻耘暈載蚤葬燥原擇蚤葬灶早, 載隕耘再葬灶早,蘊蚤允蚤葬灶,蘊哉月蚤灶援栽澡藻孕藻燥責造藻蒺澤勻燥澤責蚤賊葬造燥棗醞葬葬灶澤澡葬灶悅蚤賊贈,醞葬葬灶澤澡葬灶圓源猿園園園,悅澡蚤灶葬 【粵遭澤賊則葬糟賊】搖韻遭躁藻糟賊蚤增藻搖栽燥藻增葬造怎葬賊藻賊澡藻藻棗棗藻糟賊燥棗皂葬早灶藻賊蚤糟灶葬增蚤早葬賊蚤燥灶蚤灶賊藻則造燥糟噪蚤灶早蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造蚤灶賊澡藻賊則藻葬賊皂藻灶賊 燥棗棗藻皂燥則葬造澤澡葬棗賊棗則葬糟賊怎則藻葬灶鑿糟燥皂責葬則藻蚤賊憎蚤賊澡賊澡藻藻棗棗藻糟賊燥棗糟燥皂皂燥灶蚤灶賊藻則造燥糟噪蚤灶早蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造援醞藻賊澡燥鑿澤搖源圓糟葬澤藻澤憎藻則藻 鑿蚤增蚤鑿藻鑿蚤灶賊燥賊憎燥早則燥怎責澤援員愿糟葬澤藻澤蚤灶早則燥怎責粵憎藻則藻賊則藻葬賊藻鑿憎蚤賊澡皂葬早灶藻賊蚤糟灶葬增蚤早葬賊蚤燥灶蚤灶賊藻則造燥糟噪蚤灶早蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造葬灶鑿圓源糟葬鄄 澤藻澤蚤灶早則燥怎責月憎藻則藻賊則藻葬賊藻鑿憎蚤賊澡糟燥皂皂燥灶蚤灶賊藻則造燥糟噪蚤灶早蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造援栽蚤皂藻糟燥灶澤怎皂責賊蚤燥灶燥棗澤怎糟糟藻澤澤棗怎造鑿蚤澤賊葬造灶葬蚤造造燥糟噪蚤灶早, 燥灶藻原賊蚤皂藻造燥糟噪蚤灶早則葬賊蚤燥葬灶鑿棗則葬糟賊怎則藻澡藻葬造蚤灶早賊蚤皂藻蚤灶賊憎燥早則燥怎責澤憎藻則藻燥遭澤藻則增藻鑿援醞葬再怎葬灶原扎澡葬灶早藻賊葬造澤糟燥則藻澤贈澤賊藻皂憎葬澤怎澤藻鑿 賊燥藻增葬造怎葬賊藻賊澡藻藻棗棗藻糟賊燥棗賊則藻葬賊皂藻灶賊蚤灶藻葬糟澡早則燥怎責援砸藻澤怎造賊澤搖栽澡藻葬增藻則葬早藻賊蚤皂藻糟燥灶澤怎皂責賊蚤燥灶燥棗澤怎糟糟藻澤澤棗怎造鑿蚤澤賊葬造灶葬蚤造造燥糟噪蚤灶早蚤灶 早則燥怎責粵憎葬澤(苑援苑依圓援園)皂蚤灶怎賊藻澤葬灶鑿(員猿援緣依圓援圓)皂蚤灶怎賊藻澤蚤灶早則燥怎責月援栽澡藻則藻憎葬澤葬澤賊葬賊蚤澤賊蚤糟葬造鑿蚤棗棗藻則藻灶糟藻遭藻賊憎藻藻灶賊憎燥 早則燥怎責澤(孕約園援園緣)援栽澡藻葬增藻則葬早藻燥灶藻原賊蚤皂藻造燥糟噪蚤灶早則葬賊蚤燥蚤灶早則燥怎責粵憎葬澤怨源援源豫葬灶鑿苑緣援園豫蚤灶早則燥怎責月援栽澡藻則藻憎葬澤葬澤賊葬賊蚤澤賊蚤鄄 糟葬造鑿蚤棗棗藻則藻灶糟藻(孕約園援園緣)援栽澡藻葬增藻則葬早藻棗則葬糟賊怎則藻澡藻葬造蚤灶早賊蚤皂藻蚤灶早則燥怎責粵憎葬澤員遠援苑依員援遠憎藻藻噪澤葬灶鑿員遠援緣依員援愿憎藻藻噪澤蚤灶 早則燥怎責月援栽澡藻則藻憎葬澤灶燥澤賊葬賊蚤澤賊蚤糟葬造鑿蚤棗棗藻則藻灶糟藻(孕躍園援園緣)援栽澡藻藻曾糟藻造造藻灶賊轅早燥燥鑿則葬賊藻憎葬澤愿愿援怨豫蚤灶早則燥怎責粵葬灶鑿愿苑援緣豫蚤灶早則燥怎責 月援栽澡藻則藻憎葬澤灶燥澤賊葬賊蚤澤賊蚤糟葬造鑿蚤棗棗藻則藻灶糟藻(孕躍園援園緣)援悅燥灶糟造怎澤蚤燥灶搖鄖燥燥鑿藻棗棗藻糟賊蚤澤葬糟澡蚤藻增藻鑿蚤灶皂葬早灶藻賊蚤糟灶葬增蚤早葬賊蚤燥灶蚤灶賊藻則造燥糟噪蚤灶早 蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造蚤灶賊澡藻賊則藻葬賊皂藻灶賊燥棗棗藻皂燥則葬造澤澡葬棗賊棗則葬糟賊怎則藻,憎澡蚤糟澡澡葬澤葬鑿增葬灶賊葬早藻燥棗皂燥則藻葬糟糟怎則葬賊藻責燥澤蚤賊蚤燥灶,造藻澤澤燥責藻則葬賊蚤燥灶 賊蚤皂藻葬灶鑿造藻澤澤賊則葬怎皂葬糟燥皂責葬則藻鑿憎蚤賊澡糟燥皂皂燥灶蚤灶賊藻則造燥糟噪蚤灶早蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造援 【運藻贈憎燥則鑿澤】搖醞葬早灶藻賊蚤糟灶葬增蚤早葬賊蚤燥灶;搖隕灶賊藻則造燥糟噪蚤灶早蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造;搖云藻皂燥則葬造澤澡葬棗賊棗則葬糟賊怎則藻 搖搖股骨干骨折的治療方法多種多樣,近年來交鎖髓內釘在 治療股骨骨折內固定中具有較明顯的優勢 [員]。筆者所在醫 院圓園園遠年圓月耀圓園園怨年員員月使用山東濰坊三維骨科醫療 器械研究所生產的磁力導航交鎖髓內釘和蘇州艾迪爾醫療 器械有限公司生產的普通交鎖髓內釘,共治療股骨干骨折源圓 例,取得了滿意的療效。 員搖資料與方法 員郾員搖一般資料搖本組源圓例,男猿園例,女員圓例,年齡員愿耀緣怨 歲。按照使用磁力導航交鎖髓內釘和普通交鎖髓內釘治療 分為兩組,粵組員愿例,磁力導航交鎖髓內釘治療,男員源例,女 源例,年齡員苑耀源苑歲。閉合性骨折員緣例,開放性骨折猿例 (均為鄖怎澤賊蚤造燥 Ⅰ 型)。按照粵韻的醞怎造造藻則 [圓]分類法: 粵員型愿 ·怨愿· 換頁 中國醫學創新搖圓園員園年員員月搖第苑卷第猿員期搖醞藻鑿蚤糟葬造隕灶灶燥增葬賊蚤燥灶燥棗悅澡蚤灶葬,暈燥增藻皂遭藻則援圓園員園,災燥造郾苑暈燥郾猿員 例,粵圓型遠例,月員型圓例,悅員型員例,悅圓型員例。月組圓源例, 普通交鎖髓內釘治療,男員遠例,女愿例,年齡員苑耀緣緣歲。閉 合性骨折員愿例,開放性骨折遠例(均為鄖怎澤賊蚤造燥 Ⅰ 型)。粵員型 愿例,粵圓型緣例,粵猿型源例,月員型猿例,月圓型圓例,悅員型員例, 悅圓型員例。兩組均由同一術者完成手術,且骨折部位相似, 骨折分型相似,具有可比性。 員郾圓搖手術方法搖由大粗隆近端至骼骨翼水平位行直切口長 約緣糟皂,選擇大粗隆頂點偏內后測為進針點,用開口器鉆透 骨皮質,插入導針,閉合或小切口開放復位骨折端,髓腔擴大 器通過骨折處擴髓,用打入器置入合適的髓內釘。鎖遠端鎖 釘時,磁力導航交鎖髓內釘步驟:(員)術前,安裝好髓內釘和 定位桿。鉆套及鉆頭放入定位桿遠端第員孔,調整定位桿高 度使鉆頭對準髓內釘第員孔,固定定位桿。探測器放入定位 桿前端第圓孔。將探針插入髓內釘中心孔,讓探針磁塊對準 遠端第圓孔,旋轉探針至聲控器發出提示音后用卡片鎖死。 (圓)術中,置入髓內釘后將探針插入髓內釘中心孔,按術前鎖 死位置原位鎖定。安裝定位桿,用探測器探頭接近骨面,調 整定位桿,磁力最大處定位。先打入遠端第員孔。卸下探測 器,用代釘器固定,打入遠端第圓孔。普通交鎖髓內釘步驟: 先固定壓桿和連接桿,再借助三維瞄準器定位,依次鎖定遠 端圓枚交鎖釘。均使用導向器下打入近端圓枚鎖釘。最后在 髓內釘近端上螺帽封閉釘腔,悅臂載線機透視檢查鎖釘情 況,縫合切口。術中記錄兩組遠端圓枚鎖釘鎖定成功時間、 一次性鎖定成功率。 員郾猿搖術后處理搖應用抗生素源耀苑鑿。不作外固定。術后 圓源澡鼓勵患者早期行髖、膝、踝關節功能鍛煉。術后員周扶雙 拐下地,患肢輕度負重。術后每個月復查載線片員次,提示 有骨痂生長后允許患者逐漸去拐負重行走。記錄骨折愈合 時間并評價兩組療效。 員郾源搖統計學處理搖應用雜孕雜雜員圓郾園軟件進行統計。計量資 料以曾依澤表示,顯著性比較采用賊檢驗,計數資料采用 χ 圓 檢 驗,以孕約園郾園緣為差異具有統計學意義。 圓搖結果 遠端圓枚鎖釘鎖定成功時間:粵組(緣郾愿耀員猿郾苑)皂蚤灶,平 均(苑郾苑依圓郾園)皂蚤灶;月組員園郾遠耀圓猿郾愿皂蚤灶,平均(員猿郾緣依圓郾圓) 皂蚤灶;兩組差異有統計學意義(孕約園郾園緣)。一次性鎖定成功 率:粵組怨源郾源豫,月組苑緣郾園豫,兩組差異有統計學意義(孕約 園郾園緣)。骨折愈合時間:粵組員員郾怨耀圓猿郾愿周,平均員遠郾苑依員郾遠 周;月組員員郾遠耀圓源郾苑周,平均員遠郾緣依員郾愿周;兩組差異無統計 學意義(孕躍園郾園緣)。根據馬元璋等 [猿]評分標準評價兩組療 效:粵組優員源例,良圓例,中圓例,差園例,優良率愿愿郾怨豫;月 組優員愿例,良猿例,中猿例,差園例,優良率愿苑郾緣豫;兩組差異 無統計學意義(孕躍園郾園緣)。 猿搖討論 猿郾員搖磁力導航交鎖髓內釘比普通交鎖髓內釘的優勢搖目前 雖然交鎖髓內釘治療股骨干骨折的療效令人滿意,但遠端鎖 釘的放置失敗在手術中較常見,成為一直困擾骨科醫師的問 題。這大多是因為遠端瞄準器準確性差所致。髓內釘的變 形、連接桿的微動,都將導致定位器將無法準確定位。有文 獻報道遠端鎖釘鎖定失敗率達愿豫耀圓怨郾員豫 [源]。遠端鎖釘交 鎖時所花費的時間較長,術中有時需多次應用悅臂載線機透 視,延長了手術時間,增大出血量,增加了醫生與患者的放射 損害,增加了患者的痛苦。又因遠端鎖釘交鎖困難,反復鉆 孔致使鎖孔擴大,鎖釘容易松動退出。磁力導航髓內釘與傳 統定位桿的三維空間定位機制不同,為二維空間定位,摒除 矢狀面定位裝置以減少因繁瑣而引起的誤差,重點解決和避 免鎖釘長軸額狀面的誤差。磁力導航探測器靈敏度高,不會 受髓內釘變形、連接桿微動的影響,只要安裝正確,打孔過程 中鎖釘主軸額狀面上無偏差,一次鉆孔、鎖釘率將顯著提高。 磁力導航通過磁場作用力定位,無輻射,能夠減少載線輻射 對人體的副損傷。手術操作簡便,定位準確,解決了遠端鎖 釘難鎖的問題。同時也可以減少一個安裝壓桿時帶來的手 術切口。 猿郾圓搖鎖遠端鎖釘的操作技巧搖雖然磁力導航交鎖髓內釘比 普通交鎖髓內釘鎖遠端鎖釘的難度大大減小,但仍然需要一 定的技巧來提高準確率。筆者的經驗是:( 員)術者要熟悉磁 力導航交鎖髓內釘鎖釘的常規操作,熟悉器械每個部位及其 性能 [緣]。( 圓)術前在體外先進行一次安裝及調教,確保導航 裝置準確無誤。(猿)使用前鎖緊各個連接關節,維持穩定性, 盡量不要產生微動。(源)遠端上鎖釘的切口要剝離充分,使 探測器盡量貼近骨皮質而獲得準確的磁力定位。(緣)轉孔時 讓一名助手專門負責扶穩探測器,不讓其滑動而影響準確 定位。 磁力導航交鎖髓內釘和普通交鎖髓內釘治療股骨干骨 折的療效均令人滿意。磁力導航通過磁場作用力定位,無輻 射,減少了載線輻射對人體的副損傷。相比普通交鎖髓內釘 有定位準確,手術時間短,創傷小的優勢。值得推廣應用。 參考文獻 [員]宰燥造蚤灶澤噪贈孕砸,醞糟悅葬則賊贈耘,雜澡贈則再,藻賊葬員援砸藻葬皂藻鑿蚤灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造鄄 蚤灶早燥棗賊澡藻棗藻皂怎則:緣緣員糟葬澤藻澤援允栽則葬怎皂葬,員怨怨怨,源遠:猿怨園原猿怨怨援 [圓]王滿宜,楊慶銘,曾炳芳,等援骨折治療的粵韻原則援北京:華夏出 版社,圓園園猿:源緣原緣遠援 [猿]馬元璋,陳正中,王亦璁,等援加壓髓內釘內固定的動物試驗與臨 床應用援中華外科雜志,員怨愿苑,愿:源苑苑原源愿園援 [源]閱怎則葬噪遭葬澤葬韻,勻葬噪造葬則哉,栽怎贈早怎灶勻,藻賊葬造援隕灶賊則葬皂藻鑿怎造造葬則贈灶葬蚤造蚤灶早燥棗葬鄄 鑿怎造賊棗藻皂燥則葬造棗則葬糟賊怎則藻澤援粵糟賊葬韻則賊澡燥責栽則葬怎皂葬賊燥造栽怎則糟,圓園園圓,猿遠: 猿員遠原猿圓員援 [緣]王景彥,吳紹賓,杜奇濤,等援光磁電子導航在交鎖髓內釘遠端鎖 釘中的應用援中國矯形外科雜志,圓園園怨,員苑(圓):員緣遠原員緣苑援 (收稿日期:圓園員園原園愿原園怨) (本文編輯:張雄杰) ·園怨· 換頁

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