| Objective: To investigate the feasibility of the design of intramedullary nailing with the lateral wall of femoral great trochanter.Methods : 300 patients with hip in qinghai university affiliated hospital of three-dimensional CT data are collected,and measure the related data,to quickly locate outside wall "naked" area to provide data support,then located in 6 corpse specimens on big tuberosity vertex,piriform fossa,"naked" area of the three different into the needle point,positioning time,compare different into the needle point and hip muscles,piriformis,the distance of the medial femoral circumflex artery,from different article into the needle point into the elastic metal,then compared to take out the metal strip after legacy aperture,the size of the outside and on the basis of the metal strip Angle as a basis for the improvement of intramedullary nail;In addition,intramedullary nails were implanted from three injection points in 6 cadaver specimens,and the length of implantation was compared.All the recorded data were divided into three groups,the relevant data of the great trochanteric apex was divided into group A,the relevant data of the piriform fossa was divided into group B,and the relevant data of the "naked area" of the outer wall was divided into group C.Results:(1)the average axial vertical distance between the most uplifted part of the lateral part of the great trochanter and the "naked area" insertion point was(3.56±0.15)cm.(2)positioning time: the average time used in group A was(2.81±0.42)min.The average duration of group B was(4.16±0.44)min.The average duration used in group C was(1.70±0.42)min.The data of the three groups were statistically analyzed and showed statistical difference(F=68.212,P=0.003 < 0.05).The comparison results between the two groups also showed statistical difference.This result indicated that the "naked area" on the lateral wall of the great trocar was the most accessible,while the piriform fossa was the most difficult to reach.(3)the distance to the gluteus medius muscle: the average distance of group A was(1.63±0.14)cm;The average distance of group B was(2.60±0.13)cm.The mean distance of group C was(1.12±0.16)cm.Of three groups of data statistical analysis,statistically difference(F = 86.092,P = 0.001 < 0.05),the two comparison results also show that there are statistical differences between the two,the results suggest that large lateral tuberosity wall "naked" area recently,distance and hip muscle attachment points,compared with the great trochanter vertices and the piriform fossa,the needle into the ever more likely to be damage to the adhesion of middle part.(4)distance with piriformis: the average distance of group A was(1.16±0.11)cm;The average distance of group B was(0.10±0.06)cm.The mean distance of group C was(2.35 0.18)cm.Of three groups of data statistical analysis,statistically difference(F = 345.148,P = 0.000 < 0.05),the two comparison results also show that there are statistical differences between the two,the results suggest that greater tuberosity outside wall "naked" area and piriformis attachment point farthest,piriform fossa into the needle point and the distance of the piriformis recently,the needle into the ever more likely to be damage to the piriformis attached department,while "naked" area into the needle point is the safest.(5)distance from the medial femoral artery: the average distance of group A was(2.02±0.15)cm;The average distance of group B was(0.70±0.16)cm.The mean distance of group C was(2.83±0.17)cm.Of three groups of data statistical analysis,statistically difference(F = 412.076,P = 0.000 < 0.05),the two comparison results also show that there are statistical differences between the two,the results suggest that greater tuberosity outside wall "naked" area and the distance of the medial femoral circumflex artery,as far as the piriform fossa into the needle point recently,and the distance of the medial femoral circumflex artery,the needle into the ever more likely to be damage to the medial femoral circumflex artery,and "naked" area into the needle point is the most safe.6.The maximum diameter of the hole left after the metal strip was removed: the average value of group A was(1.35±0.11)cm;The mean value of group B was(1.37±0.13)cm.The mean of group C was(1.72±0.13)cm.The data of the three groups were statistically analyzed and showed statistical difference(F=48.127,P=0.02 < 0.05).Were analyzed between the two groups,group A and group B comparison results show that there were no significant differences,group B and group C comparative results showed A statistically difference,group A and group C comparison results also show that there are statistical differences,the results suggest that greater tuberosity and the piriform fossa into vertices into needle caused by the aperture size close to,there was no significant difference,and outside wall "naked" area into the aperture of the needle is significantly greater than the other two,needle point,there are statistical differences,this also shows that the needle into some larger the diameter of the hole is needed to put nails,bone defect caused by will be bullish.7.Time of intramedullary nail implantation at three different injection points: the average time used for group A was(36.21±14.26)min;The average duration of group B was(43.28±17.24)min.The average time used in group C was 37.89 16.12 min.The data of the three groups were statistically analyzed and showed statistical difference(F=47.462,P=0.008 < 0.05).Were analyzed between the two groups,group A and group B comparison results showed statistical difference,group B and group C comparative results showed A statistically difference,there was no significant difference between group A and group C as A result,the results suggest that the piriform fossa into the needle point placement intramedullary nailing the longest time and used large lateral tuberosity vertex into the needle point and wall "naked" area into the needle point used similar time.However,from the perspective of average duration,the duration of the lateral wall "naked area" insertion point is slightly longer than that of the apex of the greater trochanter,which may be due to the less application of this insertion point and the less skilled clinical operation.Conclusion:(1)the external wall of the femoral great trochanter into the intramedullary nail has its own advantages,the risk of injury of the medial femoral rotation artery,piriformis muscle attachment point is the lowest,in order to avoid iatrogenic femoral head necrosis has obvious advantages,and the most easy to be located on the body surface.(2)the lateral wall of the femoral greater trochanter into the nail need to reform the intramedullary nail,in order to adapt to more out of the needle point.(3)the improved intramedullary nail can be inserted into the lateral wall of the femoral greater trochanter,which is superior to the piriform fossa injection in terms of operating time.(4)the success of the corpse sample experiment can not be expressed in the clinical can be directly applied,there are still problems such as improved intramedullary nail,lateral wall defect is large,need further discussion. |
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