粗隆间骨折髓内钉内固定术(Gamma3)-远端锁定(Distal screw locking)-双语学习

粗隆间骨折髓内钉内固定术(Gamma3)-远端锁定(Distal screw locking)-双语学习
Distal screw locking 远端螺钉锁定Disconnect the lag screwdriver by loosening the end thumbwheel, remove the lag screwdriver, lag screw guide sleeve and the K-wire. The nature
of the fracture determines whether the distal locking screw is used.、松开末端手柄，卸下
拉力螺丝刀、拉力螺钉导向套筒和克氏针。

骨折的性质决定是否使用远端锁定螺钉。

It should be used: 远端锁定螺钉用于：If the fracture is unstable 骨折不稳定If rotational stability is required 防旋转When there is a wide disparity between the diameter of the nail and the femoral cavity 主钉与股骨髓腔直径之间存在较大差距Gamma3 nails offer the possibility to be locked distally either dynamically or statically. The fracture pattern determines the method of distal locking.髓内钉可动态或静态锁定。

骨折类型决定了远端锁定的方法。

Note: 注意These following points must be considered in
order to perform a proper distal locking procedure:进行正确的远端锁定，必须考虑以下几点:Ensure that the nail holding bolt is still fully tightened 确保固定螺丝完全拧紧Avoid
soft tissue pressure on the distal locking sleeve assembly- therefore the skin incision would
be made (co-linear) in direction of the sleeve assembly避免挤压远端锁定套管组件上的软
组织 - 皮肤切口应与套管组件在一条直线上。

Check that the distal locking sleeve assembly with the trocar removed is in contact with the lateral cortex of the femur and is locked securely with the speedlock sleeve knob. Confirm final locking screw placement with
A/P and lateral fluoroscopic X-ray.检查远端锁定套筒组件是否与股骨外侧皮质接触，并
用快速锁定套筒旋钮锁紧。

正位和侧面C臂确定螺钉的最终定位。

Neutralize the power tool weight during drilling procedure and do not apply force to the targeting arm在钻孔过程
中对定位臂不要施加力。

Start the power tool before having bone contact with the drill在
钻头与骨接触之前，先启动电钻Use sharp and center tipped drills only 使用尖锐中心尖
头钻The carbon fiber targeting device offers the option of guided distal locking in a dynamic or static position of the nail. The green coded targeting sleeve of the target arm has to be adjusted in the required position. In the following description, dynamic locking will be described. Turn the targeting sleeve until you reach the dynamic position with the point on
the target sleeve is in line where the arrow on the target arm. Push the sleeve up in the cranial direction. Now assemble the tissue protection sleeve, Gamma3 drill sleeve and Gamma3 trocar and advance it through the hole of the target arm down to the skin. 该定位装置提供了钉的动态或静态位置进行远端锁定。

定位臂的绿色编码瞄准套筒必须调整到所需位置。

下面描述动态锁定：转动瞄准套筒，直到定位套筒上的点与定位臂上的箭头位置一致
即为动态锁定位置。

把套筒向头侧方向推。

组装组织保护套、Gamma3钻套和
Gamma3套管针，并将其穿过定位臂的孔向下推至皮肤。

A small incision is started at
the tip of the trocar, and is extended down to the lateral cortex (Fig. 64). The trocar will extend beyond the sleeve by approx. 3mm when the tissue protection sleeve has reached the lateral cortex (Fig. 65). Before locking the sleeve, gently turn the speedlock sleeve knob clockwise, making sure that the tissue protection sleeve is in good contact with the bone (Fig.
65).在套管针的尖端做小切口，向下达外侧皮质（图64）。

当组织保护套到达外侧皮
质时，套管针超过套管约3mm（图65）。

在锁定套管之前，顺时针轻轻转动快速锁定套筒旋钮，确保组织保护套与骨保持良好接触（图65）。

The Trocar is now removed and replaced by the calibrated green coded 4.2mm × 300mm drill. Drill through the first cortex and as the second cortex is reached read off the measurement on the drill scale. Add the thickness of the cortex, which is approximately 5mm, to this measurement to select the correct screw length (Fig. 66a). 现在取下套管针，换上校准的绿
色编码 4.2mm×300mm钻头。

钻透外侧皮质，当到达对侧皮质时，读出钻上的测量值。

在测量中应加入皮质厚度约为5mm，选择正确的螺钉长度(图66a)。

Proceed to drill the second cortex. Alternatively, the drill can be drilled through the second cortex and monitored by X-ray or image intensifier. The screw length can then be read directly from the scale on the drill (Fig. 66b). 或者，继续钻入，钻透对侧皮质，并通过C 臂进行监控，然后可以直接从钻头上的刻度读出螺钉的长度(图66b)。

Proceed to drill the second cortex. It is also possible to measure the correct screw length using the screw gauge after drilling through the second cortex. The drill guide sleeve must be
removed and the screw gauge may be advanced through the tissue protection sleeve. Put the small hook behind the medial cortex and read the required locking screw length from the scale.在钻透对侧皮质后，也可以用测深尺测量正确的螺钉长度。

测量前拆卸钻导向套，测深尺可以通过组织保护套向前推进，将小钩勾到对侧皮质后，从刻度上读出所需的
锁定螺钉长度。

Caution: 小心Make sure that the tissue protection sleeve/drill sleeve Assembly is seated on bone prior to selecting final screw length.在选择最终螺钉长度之前，确保组织保护套筒/钻套组件与骨接触。

Insert the 5mm distal locking screw (Fig. 67) through the distal tissue protector by using the 3.5mm screwdriver until the mark on the screwdriver shaft approaches the protector; advance the screw head carefully until it is slightly in direct contact with the cortex.用3.5mm螺丝刀将5mm远端锁紧螺钉(图67)插
入远端组织保护器，直到螺丝刀上的标记接近保护器为止; 小心地将螺钉向前推进，
直到与皮质接触。

Caution: 小心When the mark on the screwdriver shaft reaches the tissue protection sleeve, this indicates that the screw head is near the cortex (Fig. 67a). Take care not to overscrew.
The screw head should come just into contact with the cortex and resistance should be felt.当
螺丝刀上的标记到达组织保护套时，这表明螺钉头靠近皮质（图67a）。

注意不要过
度拧紧，能感觉到螺钉头与皮质接触的阻力。