| After a hundred years of development, intramedullary nailing has become the preferred technology of long bone fracture fixation. With the emergence of new types of intramedullary nails, intramedullary nail will play a greater role in orthopedic clinical treatment as a simple, reliable fixation.In changing today, some changes are taking place in the concept of inherent. With the change in the principles of orthopedic fixation, all operations are centered on the principles which take as little as possible damage to soft tissue, blood supply, and spend less time on operation. This is also the direction of intramedullary nail. Generally intramedullary locking screw was implanted under the special sight, but the distal locking screw was placed in more difficult, prone to complications. So, morphological and anatomical study of lower extremity long bone and marrow is very important to the accuracy of blind implantation of distal locking nail. In this study, we used normal adult specimens, collected cases of lower limb fractures treated with intramedullary nail and studied the structure and morphology of lower limb bones. Through a combination of clinical and basic research data, we attempts to provide a simple and feasible method for clinical application of intramedullary nail.Objective:The purpose of this research project was to take a feasibility study of blind implantation of distal locking nail of interlocking intramedullary nail, through researching anatomy of the lower limb long bone marrow cavity and the clinical cases. And this investigation may provide the basis in order to reduce complications related intramedullary nail in the treatment of lower limb fracture.Methods:We use DR radiography machine for lower limb long bone marrow imaging. After surgery, patients who were used of intramedullary nailing for lower limb bone fracture received radiography. We reviewed 72 patients treated for lower limb fracture using interlocking intramedullary nail. The distal locking nail was implanted using blind implantation method. We screwed locking nail when see the main hole of the intramedullary nail under direct vision.Results:By the images we get from x-ray machine, we can accurately observe the specimen shape and the angle of measurement samples. In the sagittal plane, Chinese people's femur has two curvature. In the case of nail in the design and the distal locking screw insertion, we should consider the morphological. In the sagittal plane, the Chinese form of the tibia is not very different. The distal nail basically located in the middle position of the tibia lateral side. Through the imaging detection of the lower limb bone, We can see that the proximal locking screw located in the distal femoral cancellous bone near the lower 1/3 junction, distal tibial proximal locking screw located in position of the middle of the cancellous bone, and the distance between proximal locking nail to the distal locking nail was about 1.5～2.0 cm. Bone healing had occurred in all patients at the time of follow-up after 6 to 24 months.14 delayed union cases got fracture healing in 3 months after the dynamization. All of the proximal and distal locking nails were eutopic. No locking nail fracture and exit.Conclusions:Through lower limb long bone marrow imaging and femur, tibia anatomical shape analysis and related research, we obtain a theoretical basis of blind implantation with distal locking screw of distal limb interlocking intramedullary nail. Our study confirmed that the blind implantation method is simple and feasible. It not only reduced iatrogenic X-ray radiation and operation time, but also made the interlocking intramedullary nail to be more minimally invasive technique. |
PDF Full Text Request