链接:https://pan.baidu.com/s/1OLMWGzXfolCBV2NCmk979w 不同产家股骨髓内定进针点要求是不同的,2005年作者选取了4种不同厂家髓内钉:Holland Nail (Biomet, Warsaw, IN)、Trochanteric Antegrade Nail (TAN, Smith & Nephew, Memphis, TN)、Gamma nail (2nd and 3rd generations, Howmedica/Osteonics,Mahwah, NJ)和Trochanteric Fixation Nail (TFN, Synthes,Paoli, PA)。Holland近端10°成角,TAN近端5°成角,Gamma近端4°成角,TFN近端6°成角。选用3种不同进针点,大转子顶点和内外侧3mm。 选取不同进针点,顶点及内外侧3mm。 大转子顶点进针,不同厂家髓内钉对于骨折复位的影响。FIGURE 2. A, Femur #9, tip insertion site with Holland nail (Biomet). B, Femur #9, tip insertion site with Trochanteric Antegrade Nail. C, Femur #9, tip insertion site with Gamma 3 nail. D, Femur #9, tip insertion site with Trochanteric Fixation Nail. Note varus at osteotomy site with all 4 nails despite introduction from the tip of the greater trochanter. 作者通过研究认为大转子顶点对于不同髓内钉是常规进针点,进针点靠外会引起内翻畸形和骨折复位丢失(外侧骨折间隙增大),术中应避免,即使偏外2-3mm。不同的进针点,髓内钉弯曲的位置,弯曲的角度,甚至患者自身的颈干角解剖特点,髓内钉插入的深度都会对复位质量造成影响。
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