本文選題：前內(nèi)側(cè)入路 + 股骨遠(yuǎn)端骨折　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)于股骨遠(yuǎn)端骨折的治療,骨科醫(yī)師往往采用外側(cè)入路,其被認(rèn)為是治療股骨遠(yuǎn)端骨折的標(biāo)準(zhǔn)手術(shù)入路。然而,經(jīng)此入路行內(nèi)固定治療僅僅對(duì)骨折外側(cè)進(jìn)行了支撐,而對(duì)于內(nèi)側(cè)面缺乏有效的支撐,致使術(shù)后骨折內(nèi)翻畸形、骨折不愈合等情況時(shí)有發(fā)生,最終因力線(xiàn)不正導(dǎo)致內(nèi)固定的斷裂。由于目前對(duì)股骨遠(yuǎn)端內(nèi)側(cè)面研究的文獻(xiàn)較少,骨科醫(yī)師對(duì)股骨遠(yuǎn)端內(nèi)側(cè)面解剖結(jié)構(gòu)缺乏了解,認(rèn)為實(shí)施內(nèi)側(cè)入路易損傷股動(dòng)脈,所以骨科醫(yī)師多采用外側(cè)入路治療股骨遠(yuǎn)端骨折。此項(xiàng)研究目的在于通過(guò)對(duì)尸體解剖來(lái)確定股骨遠(yuǎn)端內(nèi)側(cè)面的解剖結(jié)構(gòu),同時(shí)對(duì)正常人大腿遠(yuǎn)端進(jìn)行核磁共振掃描,測(cè)量股動(dòng)脈在不同位置上與設(shè)計(jì)的手術(shù)入路之間的距離,探索出一條安全可行的內(nèi)側(cè)手術(shù)入路。方法:在一具新鮮尸體的大腿遠(yuǎn)端實(shí)施設(shè)計(jì)的手術(shù)入路,逐層分離暴露軟組織,研究各組織結(jié)構(gòu)的層次關(guān)系以及股動(dòng)脈與手術(shù)入路的關(guān)系和安全距離。此外,我們通過(guò)對(duì)20名年輕的成年人的大腿遠(yuǎn)端進(jìn)行核磁共振掃描,以膝關(guān)節(jié)間隙為起點(diǎn),到距其20cm近端為掃描對(duì)象,以2cm的間距進(jìn)行橫斷面掃描,收集所有的圖像數(shù)據(jù),同時(shí)在每一層面測(cè)量記錄手術(shù)入路和股動(dòng)脈之間的距離。結(jié)果:在解剖過(guò)程中,重要的神經(jīng)血管未受到損害,股骨和股動(dòng)脈之間存在一安全區(qū)域可以在股骨遠(yuǎn)端內(nèi)側(cè)面安全地實(shí)施手術(shù)。同時(shí)核磁共振掃描數(shù)據(jù)結(jié)果為:股骨遠(yuǎn)端內(nèi)側(cè)面距離股動(dòng)脈的距離最短為23.34-25.05mm,平均距離為24.93mm,95%可信區(qū)間為22.54-26.35mm,此最短距離所在位置大概距離膝關(guān)節(jié)10cm。結(jié)論:對(duì)于復(fù)雜的股骨遠(yuǎn)端骨折,經(jīng)前內(nèi)側(cè)入路實(shí)施手術(shù)是安全可行的。這為骨科醫(yī)師對(duì)一些難以處理的骨折的治療提供了一種可供選擇的方案。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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