本文選題：脛骨干骨折 + 髓內(nèi)釘��； 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)對(duì)門診患者和自愿者拍攝雙小腿標(biāo)準(zhǔn)全長(zhǎng)正側(cè)位X線片,在X線片上測(cè)量脛骨結(jié)節(jié)最高點(diǎn)至脛骨軸線間的垂直距離,確定國(guó)人最佳脛骨髓內(nèi)釘進(jìn)針點(diǎn)在冠狀位與脛骨結(jié)節(jié)最高點(diǎn)的關(guān)系,試圖尋求一種簡(jiǎn)單準(zhǔn)確的確定正確進(jìn)針點(diǎn)的方法,為脛骨干骨折行髓內(nèi)釘內(nèi)固定術(shù)髓內(nèi)釘進(jìn)針點(diǎn)的選擇提供參考依據(jù)。方法:對(duì)2015年11月至2016年10月前來(lái)延安大學(xué)附屬醫(yī)院創(chuàng)傷骨科門診就診的患者和志愿者共40位拍攝雙小腿標(biāo)準(zhǔn)正側(cè)位全長(zhǎng)(包踝關(guān)節(jié)、膝關(guān)節(jié))X線片。拍攝X線時(shí),膝關(guān)節(jié)盡量伸直,下肢處于中立位,髕骨垂直向上,在脛骨結(jié)節(jié)最高點(diǎn)處皮膚上作出標(biāo)記,放置直徑為3mm金屬小球。拍攝X線后,把金屬小球在X線片上顯影小圓點(diǎn)的圓心作為脛骨結(jié)節(jié)在X線上的投影,在X線片上畫出脛骨軸線。測(cè)量脛骨結(jié)節(jié)最高點(diǎn)至脛骨軸線的垂直距離,計(jì)算其95%置信區(qū)間。再將80個(gè)下肢分別按性別、左右側(cè)進(jìn)行分組,對(duì)其測(cè)量結(jié)果進(jìn)行比較,采用兩獨(dú)立樣本t檢驗(yàn)。結(jié)果:1.80例下肢的脛骨結(jié)節(jié)體表投影74個(gè)位于脛骨軸線的外側(cè),6例位于脛骨軸線的內(nèi)側(cè),男4例,右腿2例,左腿2例;女2例,右腿1例,左腿1例;脛骨結(jié)節(jié)與脛骨軸線的垂直距離為(3.27±0.32)mm,95%置信區(qū)間為(3.20mm,3.34mm)。2.按性別分組,對(duì)測(cè)量結(jié)果進(jìn)行比較時(shí),男性組脛骨結(jié)節(jié)與脛骨軸線的垂直距離為:(3.28±0.32)mm;女性組脛骨結(jié)節(jié)與脛骨軸線的垂直距離為:(3.27±0.32)mm。男女兩組數(shù)據(jù)進(jìn)行比較時(shí):差異無(wú)統(tǒng)計(jì)學(xué)意義,(P=0.8610.05)。3.當(dāng)以左右側(cè)肢體不同對(duì)80例下肢進(jìn)行分組,對(duì)測(cè)量結(jié)果進(jìn)行比較時(shí),左側(cè)組脛骨結(jié)節(jié)與脛骨軸線的垂直距離為:(3.26±0.28)mm;右側(cè)組脛骨結(jié)節(jié)與脛骨軸線的垂直距離為:(3.32±0.35)mm。左右側(cè)兩組數(shù)據(jù)進(jìn)行比較時(shí):差異無(wú)統(tǒng)計(jì)學(xué)意義,(P=0.3940.05)。結(jié)論:脛骨結(jié)節(jié)在脛骨近端的解剖標(biāo)志中最容易確認(rèn),通過(guò)脛骨結(jié)節(jié)解剖標(biāo)志確定脛骨髓內(nèi)釘進(jìn)針點(diǎn),操作簡(jiǎn)單可靠。通過(guò)實(shí)驗(yàn)研究確定脛骨軸線位于脛骨結(jié)節(jié)內(nèi)側(cè)或外側(cè)(3.27±0.32)mm處,該位置也是髓內(nèi)釘最佳進(jìn)針點(diǎn),內(nèi)側(cè)居多,其中性別、左右側(cè)下肢對(duì)研究結(jié)果無(wú)明顯影響。相比較國(guó)外研究脛骨軸線在冠狀面位于脛骨結(jié)節(jié)偏內(nèi)0.5-1.0cm處,國(guó)人脛骨軸線在冠狀面更靠近脛骨結(jié)節(jié)中點(diǎn)。
[Abstract]:Objective: to measure the vertical distance from the highest point of tibial tubercle to the axis of tibia by taking the standard full-length radiographs of both legs from outpatient patients and volunteers, and to measure the vertical distance between the highest point of tibial nodule and the axis of tibia on X-ray film. To determine the relationship between the best tibial intramedullary pin point and the highest point of tibial nodule in Chinese, we try to find a simple and accurate method to determine the correct point of insertion. To provide a reference for the selection of intramedullary nail insertion point for tibial shaft fracture with intramedullary nail fixation. Methods: from November 2015 to October 2016, 40 patients and volunteers who came to the Department of Orthopaedics, affiliated Hospital of Yan'an University to visit the Department of Trauma and Orthopedic Department from November, 2015 to October, 2016, were selected to photograph the full length of the standard anteroposterior and lateral leg (including ankle joint and knee joint). The knee joint was as straight as possible, the lower limb was in neutral position, the patella was vertical upward, the skin was marked at the highest point of the tibial tubercle, and the diameter of the metal ball was 3mm. After the X-ray film, the center of the metal ball on the X-ray film was used as the projection of the tibial nodule on the X ray, and the axis of the tibia was drawn on the X ray film. The vertical distance from the highest point of the tibial nodule to the tibial axis was measured and its 95% confidence interval was calculated. Then 80 lower limbs were divided according to sex, left and right side, the results were compared and two independent samples t test were used. Results 74 cases were located on the medial side of the tibial axis, including male 4 cases, right leg 2 cases, left leg 2 cases, female 2 cases, right leg 1 case, left leg 1 case. The vertical distance between tibial nodule and tibial axis is 3.27 鹵0.32 mm / 95% confidence interval is 3.20 mm / 3.34 mm 路2. The vertical distance between tibial nodule and tibial axis in male group was 3.28 鹵0.32 mm, and that in female group was 3.27 鹵0.32 mmm. When comparing the two groups of data: the difference was not statistically significant (P < 0. 8610.05). The vertical distance between the tibial nodule and the tibial axis in the left group was 3.26 鹵0.28 mm, and the vertical distance between the right tibial nodule and the tibial axis was 3.32 鹵0.35 mmm. The difference between the two groups was not statistically significant (P = 0.3940.05). Conclusion: tibial nodule is the most easily identified anatomic marker in proximal tibia. It is simple and reliable to determine the insertion point of tibial intramedullary nail by tibial nodule anatomic marker. The tibial axis is located at the medial or lateral part of the tubercle of the tibia (3.27 鹵0.32)mm). This position is also the best entry point for the intramedullary nail. The medial point is the most common. Sex and lower extremity of the left and right side have no significant effect on the results. The tibial axis is located on the coronal plane at the inner 0.5-1.0cm of the tibial tubercle, and the Chinese tibial axis is closer to the middle point of the tibial tubercle in the coronal plane.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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