脛骨順行髓內(nèi)釘手術(shù)入路

1、1.Skin incision 皮膚切口Make a longitudinal skin incision from lower pole patella to the tibial tuberosity The incision is centered over the patellar ligament.Relationship to patellar ligament 與髕腱關(guān)系The patellar ligament can either be split in the middle, or retracted after dividing the fascia on either

2、the medial or lateral side. The entry site should be centered over the tibial medullary canal?？梢詮捏x腱中間或內(nèi)側(cè)（外側(cè)）切開進入，最好位于骨髓腔上方。Mobilizing the fat pad 移動脂肪墊Identify the anterior edge of the tibial plateau and release the retro-patellar fat pad from the tibia.Move it posteriorly without opening the knee j

3、oint.確定脛骨平臺前側(cè)邊緣，從脛骨前上顯露分離髕下脂肪墊，將其向后推，不要打 開膝關(guān)節(jié)囊。Retro-patellar fat padDetermination of the entry point 確定進入點The nail entry point, on the lateral view, varies depending on nail design.The recommendations for the selected nail must therefore be carefully considered. The more proximal the entry point, t

4、he less likely it is to create a large anterior tibial defect from reaming.The nail must clear the patella, but not penetrate the posterior tibial cortex. It is first aimed slightly posteriorly, but then redirected along the medullary canal.髓內(nèi)釘?shù)倪M入點，在側(cè)位上，主要依據(jù)髓內(nèi)釘設(shè)計。進入點越靠近脛骨近端，越少可能引起一個巨大脛骨前擴孔骨缺損。髓內(nèi)釘必須離

5、開髕骨，并且不要穿出脛骨后皮質(zhì)，首先，可向后方稍微傾斜，進 入后沿髓腔向下（如下圖示）Entry point location 進入點位置The entry point is on the anterior edge of the tibial plateau, missing the menisci and centered over the medullary canal on the AP view.進入點應(yīng)位于脛骨平臺前緣，遠(yuǎn)離半月板，在正位象位于髓腔中央。6.Opening the cortex 脛骨開口Different instruments are available for

6、opening the cortex. A cannulated drill or cannulated cutting instrument can be inserted over a guide wire or pin.Alternatively, a curved entry site awl may be used, according to the surgeonspreference. Initial placement of a guide pin allows radiographic confirmation before entering the bone.開口可以使用不

7、同的器械裝置，首先置入一枚導(dǎo)針以便通過C臂確定位置。pin distally, angled 15 in the sagittal plane to the axis of the tibial shaft, into7.Insertion of centering pin 插入定位針(For cannulated cutter) Insert a 4 mm centering pin (Steinmann pin). Pass thethe proximal aspect of the medullary canal. In the coronal plane, the pin is ins

8、erted in line with the axis of the tibia shaft.Verify placement under image intensification in both planes.插入4mm定位針，在矢狀位與脛骨干呈15,冠狀位進針點與脛骨干縱軸一致。8.Opening the medullary canal with a cutter 髓腔開口Insert a cannulated cutter over the centering pin. Manually advance the cutter rotating it to remove a core of cancellous bone until the canal is entered. Use the protection sleeve in order to p