弯曲导针引导经皮逆行耻骨支螺钉固定

Curved guide wire used in percutaneous retrograde cannulated screw for superior pubic ramus fractures

摘要:

［目的］ 介绍弯曲导针引导经皮逆行耻骨支螺钉固定的手术技术和初步临床效果。［方法］ 2019 年 1 月—2020 年 3 月，采用弯曲导针引导经皮逆行耻骨支螺钉固定治疗 11 例骨盆骨折。置钉时，如导针无法通过骨折端或撞击髋臼周围骨质， 首先沿 2.5 mm 导针拧入术前预测量长度的 7.3 mm 空心螺钉至骨折线的内侧，随后将 2.0 mm 克氏针离针尖 1 cm 处折弯 5°~ 10°，作为导针通过空心螺钉置入。用螺丝刀控制空心螺钉辅助复位骨折端，调整导针的尖端指向使其通过骨折端及髋臼前上方后，沿 2.0 mm 导针继续拧入 7.3 mm 空心螺钉。待空心螺钉头部到达导针弯曲点之前将导针取出，避免螺钉切割导针尖端。 ［结果］ 所有患者均顺利完成手术，术中无神经、血管损伤等并发症发生。共置入 13 枚逆行耻骨支螺钉，每枚螺钉耗时平均 （23.77±4.79）min，透视次数平均（28.15±5.68）次，术后无感染、下肢深静脉血栓等并发症发生，所有患者于术后 3 个月骨折愈合，末次随访时骨盆功能优良率 100%。［结论］弯曲导针引导经皮逆行耻骨支螺钉固定能够降低螺钉进入髋臼的风险，提高骨折的复位质量，缩短手术时间。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of percutaneous retrograde cannulated screw for superior pubic ramus fractures by a curved guide wire. [Methods] From January 2019 to March 2020, 11 patients underwent abovesaid procedure for superior pubic ramus fractures of pelvic fractures. If the guide wire cannot pass through the fracture or impact the bone around the acetabulum, a cannulated screw 7.3 mm in diameter and length premeasured preoperatively was driven along the 2.5 mm guide wire to the inner side of the fracture, then a 2.0mm guide wire bended 5°~10° at 1cm away from the tip was used to replace the previ- ous wire through the cannulated screw. Handling the cannulated screw with a screwdriver to assist the reduction of the fracture site, and ad- just the tip of the guide needle to pass through the fracture aiming to the anterosuperior part of acetabulum, then the 7.3 mm cannulated screw was driven further along the 2.0 mm guide wire, and take out the guide wire before the tip of the cannulated screw reached the bend- ing point of the wire to prevent the screw from cutting the tip of the wire. [Results] A total of 13 patients had the retrograde superior pubic ramus screws placed smoothly with screw placement time of (23.77±4.79) minutes and number of fluoroscopies of (28.15±5.68) times. No complications, such as infection, nerve injury and lower extremity deep venous thrombosis, happened in anyone of them. All patients got fractures healing with the excellent and good rate of 100% in Majeed criteria at the latest follow-up. [Conclusion] This curved guide wire technique used in retrograde cannulated screw placement does reduce the risk of screw entering acetabulum, improve the quality of fracture reduction and shorten the operation time for superior pubic ramus fracture.