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距下关节镜专用牵引器的研制和临床应用报告

, PP. 215-219

Keywords: 距下关节,关节镜,手术疗效,手术方式

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Abstract:

目的研制距下关节镜专用牵引器,观察其有效性和安全性。方法距下关节镜专用牵引器呈矩形设计,为胫距跟平行牵引,牵引力完全与距下关节面垂直来达到最大牵引效果。16具踝关节离断新鲜标本分为2组:A组为传统无创牵引组,B组为距下关节镜专用牵引器牵引组。在相同的牵引力量下比较2组牵开的距离。测量16具标本专用牵引器的克氏针与周围血管神经肌腱结构的距离。从2006年6月至2008年5月,我们共采用距下关节镜专用牵引器治疗12例距下关节疾病,包括距下关节创伤性关节炎8例,距骨软骨损伤2例,跗骨窦综合征2例。随访采用AOFAS踝后足功能评分进行评价。结果当牵引力为5.2、10.3N水平时,A组和B组的关节间隙牵开距离差异不显著;当增大到17.6、24.4、33.8N时,B组的牵开距离均显著大于A组(P<0.05);当牵引力达到41.8N水平时,2组的牵开距离均达到最大,但B组的最大牵开间隙(3.3mm)要远远大于A组(2.2mm,P<0.01)。解剖学测量显示牵引器的克氏针与周围血管神经等结构有很好的安全距离。12例患者随访平均26.1(15~35)个月,未见任何手术并发症。最后1次随访时,优4例,良6例,一般2例,优良率达到83.3%。结论距下关节镜专用牵引器能很好地牵开距下关节,方便关节镜下手术操作,且安全性高、可操作性好。

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