【摘要】：目的:本研究擬對股骨髓腔進(jìn)行解剖學(xué)測量,分析其在三維空間上的走行軌跡,將其與股骨交鎖髓內(nèi)釘參數(shù)進(jìn)行比較,分析股骨髓腔與交鎖髓內(nèi)釘?shù)钠ヅ涠燃耙鸸晒沁h(yuǎn)端鎖釘置入困難的原因,并對股骨交鎖髓內(nèi)釘瞄準(zhǔn)器進(jìn)行改良,以解決股骨交鎖髓內(nèi)釘遠(yuǎn)端鎖釘置入困難問題。方法:選取干燥股骨標(biāo)本30具進(jìn)行CT掃描,每一股骨平均提取20幅圖像,分別測量中軸點(diǎn)及髓腔壁一周8個(gè)點(diǎn)在X、Y軸上的數(shù)據(jù)。用三維畫圖軟件畫出每一根股骨及其平均值的髓腔壁、中軸線和髓內(nèi)釘在三維空間上的形態(tài),將髓腔與髓內(nèi)釘重疊后進(jìn)行比較。分別繪出髓腔中軸冠狀面及矢狀面的折線型數(shù)據(jù)圖表,與髓內(nèi)釘數(shù)據(jù)結(jié)合模擬髓內(nèi)釘插入髓腔,觀察髓內(nèi)釘切出髓腔壁情況。結(jié)果:將股骨髓腔中軸線的平均值與髓內(nèi)釘重疊后進(jìn)行比較,在冠狀面上兩者較一致,其表面的重疊率達(dá)到了約80%;而在矢狀面上髓腔弧度明顯較髓內(nèi)釘大,其表面重疊率為約40%。股骨髓腔中軸線向內(nèi)成角11例,向外成角19例;6根成角小于1.5°,15根成角1.5°~3°,9根成角大于3°,最大為向內(nèi)成角5.7°。模擬髓內(nèi)釘插入每一根髓腔,在冠狀面上30根髓內(nèi)釘中有6根切出髓腔內(nèi)側(cè)或外側(cè)壁,切出率為20%,矢狀面上有13例髓內(nèi)釘從前緣切出,切出率為43.3%。根據(jù)測量結(jié)果分析后對股骨交鎖釘瞄準(zhǔn)器進(jìn)行改進(jìn),增加其壓桿的寬度,理論上能從根本上解決股骨交鎖髓內(nèi)釘遠(yuǎn)端鎖釘置入困難問題。結(jié)論:常規(guī)股骨交鎖髓內(nèi)釘能與大多數(shù)髓腔相匹配,但髓腔解剖結(jié)構(gòu)有一定的變異性,部分髓腔成角過大使髓內(nèi)釘發(fā)生變形是引起髓內(nèi)釘遠(yuǎn)端鎖釘置入困難的主要原因。通過增加瞄準(zhǔn)器頂桿的寬度能解決股骨交鎖髓內(nèi)釘遠(yuǎn)端鎖釘置入困難問題。
[Abstract]:Objective: the purpose of this study was to measure the femoral medullary cavity anatomically, analyze its path in three dimensional space, and compare it with the parameters of femoral interlocking intramedullary nail. The matching degree between femoral medullary cavity and interlocking intramedullary nail and the reasons for the difficulty of interlocking nail placement in distal femur were analyzed, and the improvement of the sight device of femoral interlocking intramedullary nail was carried out to solve the problem of placement of distal locking nail in femoral interlocking intramedullary nail. Methods: 30 dry femur specimens were scanned by CT, and 20 images were extracted from each femur on average, and the data of the midaxis and 8 points of the medullary cavity wall were measured on the XY axis. The three-dimensional drawing software was used to draw out the shape of each femur and its average medullary cavity, the central axis and the intramedullary nail in three dimensional space, and then to compare the medullary cavity with the intramedullary nail after the superposition of the medullary cavity and the intramedullary nail. The curves of coronal and sagittal plane of the central axis of the medullary cavity were drawn respectively, and the intramedullary nail was combined with the data of the intramedullary nail to insert the intramedullary nail into the medullary cavity to observe the wall of the medullary cavity cut out by the intramedullary nail. Results: the average value of the central axis of the femoral medullary cavity was compared with that of the intramedullary nail. The curvature of the medullary cavity on the sagittal plane was significantly larger than that of the intramedullary nail, and the surface overlap rate was about 40. The central axis of femoral medullary cavity was diagonal in 11 cases and outward in 19 cases, 6 in less than 1.5 擄, 15 in 1.5 擄~ 3 擄, 9 in more than 3 擄, and the maximum was 5.7 擄in inward. Six of the 30 intramedullary nails on the coronal plane were cut out of the medial or lateral wall of the medullary cavity, and the excision rate was 20. On the sagittal plane, 13 cases of the intramedullary nail were removed from the anterior edge, with an excision rate of 43.3%. Based on the analysis of the measurement results, the femoral interlocking nail sight was improved to increase the width of the compression rod, and the problem of placing the distal locking nail in the femoral interlocking intramedullary nail could be solved theoretically. Conclusion: the conventional interlocking intramedullary nail can match most of the intramedullary cavity, but the anatomical structure of the medullary cavity has certain variability. The deformation of some intramedullary interlocking nails is the main reason for the difficulty of insertion of the distal interlocking nail in the intramedullary nail. The problem of distal interlocking nail placement can be solved by increasing the width of the bumper rod.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張勝;;股骨交鎖髓內(nèi)針術(shù)中操作困難分析及對策[J];實(shí)用骨科雜志;2010年07期

2 胡廣健;馮錫光;陳俊柱;蔣佑升;;股骨干骨折髓內(nèi)釘固定療效分析[J];臨床骨科雜志;2010年02期

3 陶志東;孫成長;毛偉歡;吳祥宗;;經(jīng)皮鎖定加壓鋼板治療股骨干粉碎性骨折21例體會(huì)[J];浙江創(chuàng)傷外科;2010年01期

4 張曄;鄒云濤;;磁力導(dǎo)航帶鎖髓內(nèi)釘治療股骨干骨折[J];山東醫(yī)藥;2009年04期

5 趙杰;張興勝;楊晉龍;王學(xué)云;王彥科;;切開復(fù)位帶鎖髓內(nèi)針治療股骨干骨折[J];實(shí)用骨科雜志;2008年10期

6 杜奇濤;王景彥;吳紹賓;;磁力聲控導(dǎo)航交鎖髓內(nèi)釘?shù)难兄萍皯?yīng)用[J];中國中醫(yī)骨傷科雜志;2007年11期

7 閆宏偉;張捷;劉凱;王坤正;劉軍;宋金輝;張開放;袁國蓮;;股骨骨髓腔的形態(tài)學(xué)研究及其臨床意義[J];西安交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2006年03期

8 吳蔚;許建中;郭漳生;;成人正常股骨解剖測量及其在膝關(guān)節(jié)置換的臨床意義[J];中國矯形外科雜志;2006年03期

9 田勇;股骨交鎖髓內(nèi)釘?shù)难芯窟M(jìn)展[J];中國矯形外科雜志;2002年S2期

10 萬黎,張日華,黎建明,江振華,樊仕才,陳欽秀,馮登殿,趙衛(wèi)東;成人股骨髓腔的解剖學(xué)測量及彈力內(nèi)鎖釘?shù)脑O(shè)計(jì)應(yīng)用[J];中國臨床解剖學(xué)雜志;2002年03期

，

本文編號(hào)：2424033