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52 Cases of femoral intertrochanteric fracture were fixed with L-trapezoid plate,while 25 cases three cannulated lag screws with the third screw inserted at a low angle,just adjacent to medial calcar to obtain rigid fixation.
作者用切开复位,L形钢板内固定手术治疗股骨粗隆间骨折52例,用闭合复位三枚空心拉力螺钉经皮内固定治疗25例,其中第三枚螺丝钉紧贴内侧股骨矩,低角度打入。
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Methods:Twelve patients with fresh transverse fracture of patella were reviewed in the study.The hemarthrosis,blood clot,fracture fragments and soft tissues between them were cleared with arthroscopy.With the help of C-arm X-ray,the fracture was reduced with manipulation method.After the articular facet reached anatomical reduction,two Kirschners were inserted percutaneously from proximal end to distal end of fracture to fix the fragments,Two hollow screw were put along the approach of Kirschners,and tension band fixation was performed with the shape of "8".Results:All the patients were followed up averagely 12.4 months.
12例新鲜髌骨横骨折患者通过关节镜清理关节腔内的血凝块、碎骨块和骨折块之间嵌顿的软组织,直视下观察骨折复位情况以指导骨折复位固定,在C形臂X线透视下帮助骨折复位,关节镜观察关节面解剖复位后,经皮从近折端向远折端平行打入2枚克氏针固定骨折块,顺克氏针拧入2枚中空螺钉,拔除克氏针,顺螺钉空心导入钢丝,行张力带&8&字固定。
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It means that in the lower part pedicular screws must be introduced at a more convergent angle than in the upper part if we do not want to break any cortical of the vertebral body.
这意味着,假如我们不想打坏椎体的骨皮质,在椎弓根的下半部打入椎弓根螺钉时的汇聚角必须比上半部大。
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Results: It was found that there were 7 cases of screw loosening or breaking in the internal fixation ,1 case of connecting pole loosening or dropping,3 cases of concurrent infection from internal fixators loosening,4 cases of internal fixation screw entering the spinal canal,being driven into the intervertebral space or going through the vertebra body,5 cases of repeated postoperative lumbar pain,2 cases of postoperative pseudoarthrosis formation,3 cases of the height loss of the vertebra body after the internal fixators was taken out.
结果:内固定螺钉松动或断裂7例,内固定系统中的连接杆松动或退出1例,内固定松动合并感染3例,内固定螺钉进入椎管或打入椎间隙者或穿破椎体者4例,术后反复腰痛者5例,术后假关节形成2例,内固定取出后椎体高度丢失3例。
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stress concentration:应力集中
所以,本装置使得螺钉承受了人体上半身之重量,容易产生应力集中(stress concentration)的现象,导致螺钉容易断裂;此外,骨质疏松症(osteoporsis)椎体内的松质骨之骨密度大量下降,更使得螺钉有如打入一堆沙中,无法有效固定椎体.
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drivescrew:打入螺钉
driverscope驾驶仪 | drivescrew打入螺钉 | drive-throughaccess通车便道