一种改进后上螺钉在股骨颈骨折内固定安全性评估的新型透视方法

E. Terhune, Evan M. Polce, Joel C. Williams
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引用次数: 6

摘要

背景:本研究的目的是确定股骨颈的特定透视视图,以准确识别部分骨外(“内-外-内”;采用后上螺钉固定股骨颈骨折。方法:在2个合成股骨模型(1个全骨内模型和1个IOI模型)的后上侧放置3.2 mm导针。以5°间隔拍摄连续的透视图像,以确定哪些透视投影确定了IOI导针的放置位置。这些图像用于研究第二阶段的螺钉放置和评估,其中涉及使用尸体标本。在第二阶段,使用标准的后前位透视和2个侧位透视中的1个,在10个尸体标本中放置倒三角的后上位螺钉,(1)颈部与椎体直线,即0°侧位;或(2)视场下- 15°滚转。最终的透视视图(即后前位和多个侧位和斜位视图)是随机和盲法的,由10名骨科住院医师和5名骨科创伤主治医师进行审查。标本剥离软组织,检查螺钉穿孔。结果:被调查者的总体准确率为68.8%,在创伤主治医师(71.8%)和住院医师(67.4%)之间没有差异;P = 0.173)。观察者间信度中等(κ = 0.496)。解剖发现10枚螺钉中有4枚(40%)是骨外螺钉。所有骨外螺钉均采用0°侧位置入。- 15°侧滚视图是确定IOI螺钉放置的最敏感(81.7%)和特异(92.2%)视图。结论:外科医生通常使用标准的后前位和0°侧位透视来安全放置螺钉;然而,许多这些螺钉是IOI。在侧位视图下增加- 15°滚位可显著改善股骨后上颈IOI螺钉的识别。不明位置的IOI螺钉置入可能导致股骨头血液供应受损。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Novel Fluoroscopic View for Improved Assessment of the Safety of the Posterosuperior Screw in Femoral Neck Fracture Fixation
Background: The purpose of the present study was to determine specific fluoroscopic views of the femoral neck to accurately identify partially extraosseous (“in-out-in”; IOI) placement of the posterosuperior screw for fixation of femoral neck fractures. Methods: A 3.2-mm guide pin was placed in the posterosuperior aspect of 2 synthetic femur models: 1 entirely intraosseous and 1 IOI. Sequential fluoroscopic images were made at 5° intervals in order to identify which fluoroscopic projections identified IOI guide pin placement. These images were utilized to inform screw placement and assessment in the second phase of the study, which involved the use of cadaveric specimens. In Phase II, the posterosuperior screw of the inverted triangle was placed in 10 cadaveric specimens with use of a standard posteroanterior fluoroscopic view and 1 of 2 lateral views, either (1) neck in line with the shaft, i.e., 0° lateral; or (2) a −15° rollunder view. The final fluoroscopic views (i.e., the posteroanterior and multiple lateral and oblique views) were randomized and blinded for review by 10 orthopaedic residents and 5 attending orthopaedic traumatologists. Specimens were stripped of soft tissue and inspected for screw perforation. Results: Overall accuracy of respondents was 68.8%, with no difference between the attending traumatologists (71.8%) and resident surgeons (67.4%; p = 0.173). Interobserver reliability was moderate (κ = 0.496). Dissection identified that 4 (40%) of 10 screws were extraosseous. All of the extraosseous screws were placed with use of the 0° lateral view. The −15° rollunder lateral view was the most sensitive (81.7%) and specific (92.2%) view for identifying IOI screw placement. Conclusions: Surgeons often utilize the standard posteroanterior and 0° lateral fluoroscopic views to safely place screws; however, many of these screws are IOI. The addition of a −15° rollunder lateral view significantly improved identification of IOI screws in the posterosuperior femoral neck. Unidentified IOI screw placement may result in damage to the blood supply of the femoral head.
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