本文選題：脛骨干骨折 + 髓內釘　； 參考：《延安大學》2017年碩士論文

【摘要】：目的:通過對門診患者和自愿者拍攝雙小腿標準全長正側位X線片,在X線片上測量脛骨結節(jié)最高點至脛骨軸線間的垂直距離,確定國人最佳脛骨髓內釘進針點在冠狀位與脛骨結節(jié)最高點的關系,試圖尋求一種簡單準確的確定正確進針點的方法,為脛骨干骨折行髓內釘內固定術髓內釘進針點的選擇提供參考依據(jù)。方法:對2015年11月至2016年10月前來延安大學附屬醫(yī)院創(chuàng)傷骨科門診就診的患者和志愿者共40位拍攝雙小腿標準正側位全長(包踝關節(jié)、膝關節(jié))X線片。拍攝X線時,膝關節(jié)盡量伸直,下肢處于中立位,髕骨垂直向上,在脛骨結節(jié)最高點處皮膚上作出標記,放置直徑為3mm金屬小球。拍攝X線后,把金屬小球在X線片上顯影小圓點的圓心作為脛骨結節(jié)在X線上的投影,在X線片上畫出脛骨軸線。測量脛骨結節(jié)最高點至脛骨軸線的垂直距離,計算其95%置信區(qū)間。再將80個下肢分別按性別、左右側進行分組,對其測量結果進行比較,采用兩獨立樣本t檢驗。結果:1.80例下肢的脛骨結節(jié)體表投影74個位于脛骨軸線的外側,6例位于脛骨軸線的內側,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,對測量結果進行比較時,男性組脛骨結節(jié)與脛骨軸線的垂直距離為:(3.28±0.32)mm;女性組脛骨結節(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)進行比較時:差異無統(tǒng)計學意義,(P=0.8610.05)。3.當以左右側肢體不同對80例下肢進行分組,對測量結果進行比較時,左側組脛骨結節(jié)與脛骨軸線的垂直距離為:(3.26±0.28)mm;右側組脛骨結節(jié)與脛骨軸線的垂直距離為:(3.32±0.35)mm。左右側兩組數(shù)據(jù)進行比較時:差異無統(tǒng)計學意義,(P=0.3940.05)。結論:脛骨結節(jié)在脛骨近端的解剖標志中最容易確認,通過脛骨結節(jié)解剖標志確定脛骨髓內釘進針點,操作簡單可靠。通過實驗研究確定脛骨軸線位于脛骨結節(jié)內側或外側(3.27±0.32)mm處,該位置也是髓內釘最佳進針點,內側居多,其中性別、左右側下肢對研究結果無明顯影響。相比較國外研究脛骨軸線在冠狀面位于脛骨結節(jié)偏內0.5-1.0cm處,國人脛骨軸線在冠狀面更靠近脛骨結節(jié)中點。
[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.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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