前内侧入路治疗股骨远端骨折的可行性及安全性研究

发布时间：2018-04-19 10:25

本文选题：前内侧入路 + 股骨远端骨折　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:对于股骨远端骨折的治疗,骨科医师往往采用外侧入路,其被认为是治疗股骨远端骨折的标准手术入路。然而,经此入路行内固定治疗仅仅对骨折外侧进行了支撑,而对于内侧面缺乏有效的支撑,致使术后骨折内翻畸形、骨折不愈合等情况时有发生,最终因力线不正导致内固定的断裂。由于目前对股骨远端内侧面研究的文献较少,骨科医师对股骨远端内侧面解剖结构缺乏了解,认为实施内侧入路易损伤股动脉,所以骨科医师多采用外侧入路治疗股骨远端骨折。此项研究目的在于通过对尸体解剖来确定股骨远端内侧面的解剖结构,同时对正常人大腿远端进行核磁共振扫描,测量股动脉在不同位置上与设计的手术入路之间的距离,探索出一条安全可行的内侧手术入路。方法:在一具新鲜尸体的大腿远端实施设计的手术入路,逐层分离暴露软组织,研究各组织结构的层次关系以及股动脉与手术入路的关系和安全距离。此外,我们通过对20名年轻的成年人的大腿远端进行核磁共振扫描,以膝关节间隙为起点,到距其20cm近端为扫描对象,以2cm的间距进行横断面扫描,收集所有的图像数据,同时在每一层面测量记录手术入路和股动脉之间的距离。结果:在解剖过程中,重要的神经血管未受到损害,股骨和股动脉之间存在一安全区域可以在股骨远端内侧面安全地实施手术。同时核磁共振扫描数据结果为:股骨远端内侧面距离股动脉的距离最短为23.34-25.05mm,平均距离为24.93mm,95%可信区间为22.54-26.35mm,此最短距离所在位置大概距离膝关节10cm。结论:对于复杂的股骨远端骨折,经前内侧入路实施手术是安全可行的。这为骨科医师对一些难以处理的骨折的治疗提供了一种可供选择的方案。
[Abstract]:Objective: for the treatment of distal femoral fractures, orthopedic surgeons often use the lateral approach, which is considered to be the standard surgical approach for distal femoral fractures.However, internal fixation via this approach only supports the lateral side of the fracture, but lacks effective support for the medial side.Finally, the failure of the internal fixation is caused by the force line inaccuracy.Due to the lack of literature on the medial flank of the distal femur and the lack of understanding of the anatomical structure of the medial flank of the distal femur, the orthopedic surgeon believes that the medial approach to the injury of the femoral artery is carried out.Therefore, orthopedic physicians use the lateral approach to treat distal femoral fractures.The aim of the study was to determine the anatomical structure of the medial side of the distal femur by autopsies, and to measure the distance between the femoral artery at different locations and the designed approach, while MRI scans were performed on the distal thigh of the normal person.To explore a safe and feasible medial approach.Methods: a designed approach was performed on the distal thigh of a fresh cadaver to separate the exposed soft tissue layer by layer, and to study the hierarchical relationship of the tissue structure, the relationship between the femoral artery and the operative approach and the safe distance.In addition, we performed MRI scans on the distal thigh of 20 young adults, starting with the knee joint space, moving to the proximal end of their 20cm, cross-sectional scanning at 2cm spacing, and collecting all the image data.The distance between the surgical approach and the femoral artery was also measured at each level.Results: during the anatomic process, the important nerve vessels were not damaged, and there was a safe area between femur and femoral artery that could be safely operated on the medial side of the distal femur.The results of MRI scan showed that the distance from the medial side of the femur to the femoral artery was 23.34-25.05 mm, the average distance was 24.93 mm / 95% confidence interval was 22.54-26.35 mm, and the shortest distance was about 10 cm from the knee joint.Conclusion: for complex distal femoral fractures, anterior medial approach is safe and feasible.This provides an alternative for orthopedic physicians to treat difficult fractures.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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