粗隆间骨折髓内钉内固定术(Gamma3)-插主钉(Nail insertion)-双语学习

Nail insertion 插主钉

The nail is advanced through the entry point passing the fracture site to the appropriate level.

主钉穿过进针点，通过骨折部位到达适当的位置。

If dense bone is encountered, first re-evaluate that sufficient reaming has been achieved, then, if necessary, the strike plate can be attached to the targeting arm and the slotted hammer may be used to further insert the nail (Fig. 42).

如果遇到致密骨有阻力，可考虑继续扩髓，如有必要，可以将打击板连接到定向臂上，使用锤子协助插入主钉(图42)。

More commonly, the nail is positioned too proximal and correction of the nail should be carried out either by hand or by using the strike plate placed into the target device. If a higher position is required, the universal rod and slotted hammer may then be attached to the strike plate to carefully and smoothly extract the assembly. The new position is checked again with the image intensifier as described above.

经常遇到主钉插入太深，需要矫正主钉的位置，可通过徒手或使用撞击板来调整。如果需要位置高一些，则可以将通用杆和锤子连接到撞击板上，小心退出组件。用已述方法，C型臂再次确定位置。

Danger: 当心

The nail must progress smoothly, without excessive force. If too much resistance is encountered, removal of the nail and additional reaming is recommended.

主钉必须插入顺利，不能用力过大。如果遇到太大的阻力，建议拔出主钉和重新扩髓。

Note: 注意

Remove the guide wire prior  to drilling or K-wire insertion.

在钻孔或插入克氏针之前，抽出导丝。

If the nail cannot be seated manually or if there is no advancement each 

time the impactor is tapped, A/P and lateral fluoroscopic X-rays should be reviewed to determine the cause of the impingement - there may be a mismatch between the nail geometry and the medullary canal. The starting position, the femoral bow and the canal diameter should all be examined to ensure that the leading end of the nail is not impinging on the medial or anterior cortex and that the canal itself has been sufficiently reamed.

Periodically, nail removal and further reaming of the diaphysis may be required.

如果手动或用撞击器不能使主钉入位，应检查正位和侧位X光片以确定不能入位的原因（主钉几何形状与髓腔可能不匹配）。应检查进针点、股骨弓和髓腔直径，确认主钉前端是否撞击内侧或前侧骨皮质、扩髓是否充分。确定是否需要去除主钉再次扩髓。

The proximal metaphyseal flair may be undersized (particularly in young patients or those of short stature) and serve to prevent nail advancement. If this situation is encountered, a flexible reamer may be used to further widen this area to the level of lesser trochanter.

近端干骺端由于尺寸过小（特别是在年轻或身材矮小的患者中）导致插入主钉困难。如遇到这种情况，可以用柔性锉刀进一步将该区域扩大到小转子的水平。

To facilitate manual passage, the nail should be rotated 90° internally until the fracture has been passed.

为了便于手动通过，主钉应该在内部旋转90°，直到通过骨折端为止。

The final nail depth position is monitored with the image intensifier C-arm; the projected axis of the lag screw may be projected with a ruler on the monitor screen to ensure that the lag screw is placed in the optimal position.

用C型臂确定最终主钉深度;  在C臂屏幕上用直尺投影拉力螺钉的投影轴，以确保拉力螺钉能处于最佳位置。

Proceed until the axis of the lag screw hole (visible as a crescent shape on the screen) is aligned with the lower half of the femoral neck (Fig. 43). The objective of this is to ultimately position the lag screw centrally or slightly inferior in femoral head in the frontal plane.

插入主钉，直到拉力钉孔（在屏幕上可见为新月形）与股骨颈的下半部对齐（图43）。这样做的目的是最终将拉力螺钉定位在股骨头冠状面的中央或略微下方。

Note: 注意

Remove guide wire for the flexible reamer and nail insertion using guide wire handle.

使用导丝手柄拆下柔性锉刀和导丝。

When the Gamma3 Nail has been inserted to its final depth, check  the anteversion of the nail. By  using of the K-wire Clip or closed tube clip with K-wires (Fig. 44). 

当Gamma3主钉插入到最终深度时，检查钉子的前倾。使用克氏针夹或带克氏针的闭合管夹(图44)。

The K-wire clip or closed tube clip is mounted into the slots of the target arm by pressing the clip flanges together.

将夹子法兰压在一起，将克氏针夹或闭合管夹安装到定位臂的槽中。

Caution: 注意

Before proceeding ensure that the nail holding screw is still fully tightened.

The lag screw should be placed in the central position of the femoral head in the lateral view (Fig. 45).

在继续操作前，确保主钉固定螺钉完全拧紧。

主钉应在侧位片中位于股骨头的中心位置（图45）。