摘要
背景:因为胫骨近端解剖结构的特殊性,使用髓内钉作为内固定器械治疗时存在一定困难,早期报道并发症发生率较高。随着胫骨髓内钉结构设计的不断进步,以及髓内钉固定技术的不断发展,临床报道应用该技术治疗的优良率也在逐渐增高,使用髓内钉内固定治疗胫骨近端骨折有逐渐增多的趋势。目的:对髓内钉内固定治疗胫骨近端骨折的最新进展进行综述。方法:以"proximal tibial fracture","intramedullary nail","胫骨近端骨折","髓内钉内固定"为关键词。在Pub Med、Web of science、万方、中国知网等数据库进行检索,共查阅文献742篇,通过阅读文献题目及摘要,判断是否与胫骨近端骨折髓内钉内固定有关,排除文献685篇,最终纳入57篇文献进行分析。结果与结论:(1)胫骨近端解剖结构不同于胫骨干,受传统髓内钉固定技术及髓内钉结构的限制,当其用于治疗胫骨近端骨折时并发症发生率较高;(2)髓内钉治疗技术不断发展,新型髓内钉出现,增加了近端锁钉,并改进锁钉的位置和方向,对近端骨折块的把持力更强;(3)联合钢板固定、Poller钉的应用、入路的改进等髓内钉固定技术的发展,也增加了该技术对胫骨近端骨折固定的强度;(4)经多项生物力学测试,表现优于其他内固定方式,且临床应用中体现出了髓内钉固定技术的创伤小、血运破坏少、固定牢固、术后早期活动、骨折愈合时间短等优势,尤其对于胫骨近端骨折合并胫骨干骨折,近端软组织损伤重的患者,更加适合;(5)但在临床应用该技术时,术者必须对胫骨近端解剖特点有足够的了解,并能熟练掌握髓内钉技术及各种辅助技术,才能够取得满意的临床疗效。
BACKGROUND:The complexity of the anatomic structure of proximal tibia made it difficult for treatment with intramedullary nailing and rate of complications was high.With the improved design and fixation technique of the intramedullary nails,the excellent and good rate of application of this technique is also increasing.Using intramedullary nailing to treat proximal tibial fractures is getting popular.OBJECTIVE:To summarize the latest techniques of intramedullary nailing for proximal tibial fractures.METHODS:742 literatures were retrieved with keywords of“proximal tibial fracture”and“intramedullary nail”in English and Chinese respectively from PubMed,Web of science,WanFang and CNKI database.By analyzing their titles and summaries,based on the relevance to the subject,57 articles were selected for this review after excluding 685 articles.RESULTS and CONCLUSION:(1)Due to the complexity of the anatomic structure of the proximal tibia and the limitations of both the fixation techniques and the structure of traditional intramedullary nails,rates of complications were high when intramedullary techniques were used to treat proximal tibial fractures.(2)With the development of intramedullary nail technique,newly designed intramedullary nails appeared,which increased proximal intramedullary nails,improved the position and direction of lock pin.Holding power was strong on the proximal fracture blocks.(3)The introduction of techniques such as combining with plates,Poller screws and improved approval increased the strength of the fixation of proximal tibial fractures.(4)Most of the biomechanical tests have proven that compared to other techniques,intramedullary nailing provides better stability.The intramedullary nailing has advantages of being minimal invasion,less blood transport damage,strong fixation,early postoperative activity and short healing time.It is especially effective for multi-level tibial fractures and proximal tibial fractures with severe soft tissue damages.(5)Deep knowledge of the anatomic structure of the proximal tibia and nailing procedure can help surgeons achieve satisfactory clinical results.
出处
《中国组织工程研究》
CAS
北大核心
2018年第7期1126-1132,共7页
Chinese Journal of Tissue Engineering Research
基金
天津市卫生行业重点攻关项目(15KG122),课题名称:可吸收锁钉鞘预防带锁髓内钉应力遮挡的研究
关键词
胫骨骨折
内固定器
生物力学
骨折固定术
组织工程
Tibial Fractures
Internal Fixators
Biomechanics
Fracture Fixation
Tissue Engineering
