摘要目的 探讨自行研制的下肢骨折牵引复位器用于下肢长骨骨折微创手术中的骨折复位的安全性和有效性.方法 2007年2月至2009年3月采用闭合或者有限切开复位、经皮钢板螺钉内固定治疗股骨远端及胫骨干骺端骨折34例,依据AO-OTA分类标准,其中股骨远端骨折3例(33-B型2例,33-C型1例),胫骨近端骨折14例(41-A型9例,41-B型3例,41-C型2例),胫骨远端骨折17例(43-A型9例,43-B型5例,43-C型3例,其中2例为Gustilo Ⅰ a);采用闭合复位、带锁髓内钉内固定治疗胫骨干骨折36例(42-A型7例,42-B型21例,42-C型8例,其中4例为Gustilo Ⅰ a).术中均应用自行设计的下肢骨折牵引复位器辅助骨折复位.70例患者平均年龄37.6岁(17～63岁),受伤至手术的平均时间4.7 d(0.7～12.0 d).记录术中骨折复位所需时间、骨折复位所需术中C臂机透视时间.拉线测量髂前上棘至第1、2趾蹼间的直线是否大致经过髌骨中心点,判断患肢术后力线的恢复.术后记录双下肢长度(棘踝线测量)的差值以判断患肢术后长度的恢复.以术后骨折的X线正、侧位片分别测量骨折复位后内外翻、前后向成角角度.结果 70例患者术中骨折复位所需时间12.7 min(7～31 min).骨折复位所需术中X线透视时间1.3 min(0.4～3.0 min).双下肢长度的差值为(6.5±1.1)mm,双下肢力线差值为(7.0±1.8)mm.患肢术后长度及力线恢复满意.骨折复位后X线片测量,内外翻角度(2.75±0.16)°;前后向成角角度(5.13±0.51)°.结论 下肢骨折牵引复位器在下肢长骨骨折微创手术中,不但能辅助医生获得满意的骨折复位,而且能在内固定物置入过程中稳定地维持骨折复位,操作简单、使用方便.

abstractsObjective To develop a traction reductor for the reduction of lower limb fractures during the minimally invasive surgery and explore its safety and efficacy. Methods From February 2007 to March 2009, closed or limited open reduction plus percutaneous plate and screw internal-fixation were conducted in 34 patients with fracture of distal femur and tibia metaphysic, among which there were 3 distal femoral fractures (2 33-B, 1 33-C), 14 proximal tibial fractures (9 41-A, 3 41-B, 2 41-C) and 17 distal tibial fractures (9 43-A, 5 43-B, 3 43-C, 2 Gustilo Ⅰ a), according to the Association for Osteosynthesis Orthopaedic Trauma Association (AO-OTA) classification. Besides, closed reduction plus interlocking intramedullary nailing on tibial shaft fracture were applied in 36 patients (7 42-A, 21 42-B, 8 42-C,2 Gustilo Ⅰ a). All the 70 patients, with an average age of 37. 6 years ( range: 17 to 63 years) and average time before surgery of 4. 7 d (range: 0. 7 to 12. 0 d) , underwent reduction by self-designed traction reductor for lower limb fracture in the surgery. The reduction duration andx C-arm fluoroscopy time were recorded.Recovery of the force line of affected limbs after surgery was determined by whether the line from anterior superior iliac spine to the interdigit between the first and second toe-web passed the patella center. And the distance from bilateral anterior superior iliac spine to medial malleolus tip as well as the difference between lower limbs were recorded to determine the recovery of length after surgery. Meanwhile, the varus-valgus and anteroposterior angulations after reduction were measured by AP and lateral X-ray. Results The reduction duration was 12. 7 min (range: 7 to 31 min); X-ray fluoroscopy time, 1.3 min (range: 0. 4 to 3.0 min);length difference between both lower limbs ( 6. 5 ± 1.1 ) mm; and axial alignment difference ( 7.0 ± 1. 8 )mm. The X-ray result showed that varus-valgus angle was (2.75 ±0. 16)°; and anteropsterior angulation (5. 13 ± 0. 51 ) °. Conclusion The traction reductor for lower limb fracture could achieve satisfying fracture reduction in the minimally invasive surgery of distal femur, tibia metaphysic and tibial shaft fracture.