AAOS骨科教程：膝关节半伸直位胫骨髓内钉技术

AAOS骨科教程：膝关节半伸直位胫骨髓内钉技术 AAOS骨科教程:膝关节半伸直位胫骨髓内钉技术 2013-09-04 06:27 来源:丁香园 作者:紫川秀第二 编辑: orthop010 胫骨干骨折是最为常见的骨干骨折，年发生率约在6/100,000左右，髓内钉技术是目前治疗不稳定胫骨骨干骨折的首选。研究显示，胫骨髓内钉可以达到较高的骨折愈合率，可接受的肢体轴线及较少的并发症。随着髓内钉技术的日益成熟，该技术开始被应用到更加广泛的领域，如开放性胫骨骨折，近端或远端胫骨干骺端骨折等。 目前标准的胫骨髓内钉技术通常极度屈曲膝关节(120-130度)，该手术方式由Kuntscher在1940年首先应用，极度屈曲膝关节进行髓内钉置入有经髌骨和髌骨旁两种手术入路。 尽管胫骨髓内钉技术目前应用已经较为成熟，但其仍存在挑战。传统髓内钉技术，对胫骨近端四分之一的骨折，在置钉时膝关节极度屈曲，手术过程中很难维持骨折的复位，并保持较好的胫骨对线角度;尽管目前文献报道没有具体的结论，但胫骨髓内钉术后部分患者在屈膝关节时出现持续的疼痛;膝关节屈曲置钉时，难以获得满意的透视位置，术中可能需要额外的固定或切开辅助复位固定。 膝关节半伸直位胫骨髓内钉由Tornetta等人首先应用于胫骨近端1/4骨折，随后其应用逐渐广泛。较多作者认为，膝关节半伸直位较传统手术方式有较多的优势。 术中保持膝关节半伸直位，可以为骨折复位，术中透视，胫骨轴线对位等提供更好的便利条件。目前膝关节半伸直位的手术入路较多，包括外侧或内侧膝关节切开术，髌上髓内钉插入，关节外髌旁入路等。 本文对各个手术入路方式进行，着重介绍入路体位，术中如何对抗骨折致畸应力，辅助复位，以及术中影像学透视方法等。 体位 患者仰卧位在可透X线的手术床上。患侧肢体下方垫长垫子，抬高患肢，保持髌骨朝向正前方，胫骨轴线和地面平行，大腿可自由移动(图1)。C臂机置于对侧，球管透视方向和胫骨垂直或平行。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 图1:手术体位。膝关节半伸直位，下方可以垫一衬垫维持位置。 膝关节半伸直位入路 如前所述，目前该手术方法有3个手术入路(图2)。 髌旁入路:在内侧髌骨旁做手术切口，切开髌骨支持带，进入关节腔内，此手术入路需要进行髌骨半脱位; 髌上入路:也进入关节间隙内进行操作，手术切口位于髌上靠近髌骨的部位，髓内钉从髌骨和结节间沟之间进入; 第三种手术入路，和第一种类似，切口可以在髌骨的内侧或外侧，唯一不同的是不进入关节腔内(1)。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 图2:不同手术切口示意。P，髌旁;EP，关节外髌旁;SP，髌上;LP，外侧髌旁。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 表1:三种不同手术方法 下面具体介绍各种入路的手术方法: 髌上入路 髌骨上极约2cm处正中长3cm纵行手术切口，从股四头肌表面开始分离，直至关节腔内，沿结节间沟向关节腔内置入特制的带保护套筒的圆锥形套管针，至胫骨表面。确定进针位置处于胫骨平台中线位置，后采用标准髓内钉技术置入髓内钉，根据骨折类型，在近端和远端选择锁定方式。 该手术技术要求置钉时膝关节处于完全伸直位，以提供进入关节腔内的空间。注意在置钉时要调整好进钉的角度，不要过前或过后。 关节外入路 术前注意对膝关节髌骨的松弛度进行评估，以决定在内侧或外侧做手术切口，并行髌骨脱位;通常建议选择外侧手术切口，因髌骨向内侧脱位较外侧容易。 注意切开手术皮肤时不要损伤髌骨支持带，分离髌骨支持带和周围软组织，抬高髌骨支持带，使其和下层的滑膜组织分离，注意分离髌骨支持带和周围软组织时在髌骨上保留2-3mm软组织，以方便后面的手术切口关闭。使用一枚引导针，沿髌骨和滑膜表面放置至胫骨平台间棘外侧缘。使用开口器在胫骨上开口，后采用标准髓内钉技术置入髓内钉(图3)。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 图3:关节外技术。A，手术切口延伸至髌骨支持带，但保持髌骨支持带完整;B，注意手术过程中的视野问题，否则容易出现关节滑膜的损伤;C，髌骨向内或外侧脱位，后通过结节间沟置入器械。蓝色部分为股骨远端示意图。 膝关节半伸直位胫骨髓内钉技术的优势 影像学:传统胫骨髓内钉置入技术在行术中C透视时因角度的关系需要对C臂机进行不断的调整，当胫骨长度大于40cm时胫骨近端通常很难在X片上显示。 此外，在调整C臂机器的过程中容易撞击到导向针等，导致位置丢失或骨折复位丢失。在半伸直位中，患肢处于髋关节屈曲30度，膝关节屈曲30度位置，胫骨平行与地面，此时进行胫骨的正侧位透视时更为方便和实用(图4)。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 图4:C臂透视示意图。肢体和地面平行，C臂机器轴线和地面垂直，在透视时仅需要移动C臂机的线圈即可完成正侧位透视。 致畸作用力 胫骨近端四分之一骨折髓内钉术后出现最常见的畸形是尖端前内翻畸形(apex anterior varus deformity)，主要是伸膝装置，腓肠肌，腘绳肌等共同作用(图5)。有文献报道研究发现，和胫骨中段，胫骨远端骨折相比，胫骨近端骨折发生术后移位的概率显著增高(图6)。 因此在手术时需要充分考虑到上述各个肌肉对胫骨近端骨折的影响。手术时将胫骨极度屈曲可以显著增加畸形的发生，而采用伸膝位进行置钉可以有效避免上述问题。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 图5:骨折的致畸作用力。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 图6:胫骨近端骨折，膝关节屈曲髓内钉技术后容易出现骨折移位问题。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 辅助复位技术 在某些特殊类型的骨折中需要进行开放复位，如开放性损伤，关节内粉碎性骨折等。在膝关节伸直位髓内钉置入时，关节内骨折块固定等均可以在一个手术姿势下完成，无需改变位置，从而避免了改变位置可能造成的胫骨长度，轴线或旋转变化(图7)。 图7:合并损伤，手术过程中无需对体位进行调整。 髓内钉进针点 屈曲位进行髓内钉置入时，髓内钉扩髓器，髓内钉等均可能对髌骨造成撞击，因髌骨屈曲位时被后方股骨髁限制，扩髓器和髌骨撞击时容易导致初始置钉点的丢失，从而出现开口过度朝前的问题。而伸直位置钉，髌骨活动度更大，由此造成的置钉位置丢失概率更低。 讨论 Tornetta等人首次应用了伸膝位胫骨髓内钉置入术。他们对30例胫骨近端1/4骨折的患者进行了髓内钉术后随访。头5例患者为屈膝位手术方式，在术中他们发现很难控制膝关节在矢状位上轴线位置，髓内钉术后膝关节近端处于伸直位。 urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district 因此，他们对后续的患者进行了手术方式的改良，置钉时将患者的膝关节置于15度屈膝位置，术后随访资料发现，伸膝位置手术患者术后出现胫骨骨折移位的概率极低。 但膝关节伸直位胫骨髓内钉技术是一个相对较新的手术方式，没有经过较多的文献资料证明其有效性和实用性，因此临床医生对其应用存在一定的疑问。对髌骨上手术入路，有临床医生担心对股四头肌肉的医源性损伤可能导致后续的股四头肌肌力减弱;髌骨后方入路可以导致髌股关节面潜在损伤，并较难以找到准确的进针点。 Eastman等人一项对髌骨后入路置钉进针点准确性的尸体研究发现，采用和早先Cole等人报道的髌上髓内钉置入类似的技术，尽管置钉准确性在不同膝关节屈伸度时有所差异，但只有膝关节屈曲0度和屈曲50度比较时置钉准确性才有显著性差异，而在膝关节屈曲50度时，置钉准确性可以接近75%。 Celbke等人对髌骨下和髌骨上膝关节置钉技术对髌股关节面的接触力进行了尸体学研究。发现髌骨上入路时关节面的平均接触力，平均压力，峰值压力均显著高于髌骨下入路;髌骨峰值压力，髌骨上入路3.83MPa，髌骨下入路，1.26MPa，而关节面软骨细胞损伤所需要的压力则为4.5MPa，因此认为该手术入路对软骨损伤作用有限。 鉴于上述原因，有学者发展出了关节外髓内钉技术。使用该手术技术，临床医生可以在膝关节半伸直位时通过关节外间隙进行置钉，而无需损伤股四头肌。此外，因该手术技术采用了髌骨旁入路，手术对髌股关节的压力可以得到显著减少。 近期由本文作者报道的一项18例患者的研究发现，膝关节外半伸膝位置髓内钉治疗胫骨骨折术后患肢的功能效果和正常人群类似。因此作者有理由相信，大部分胫骨骨折均可以通过半伸膝位置置入胫骨髓内钉进行治疗。在作者看来，胫骨髓内钉技术的手术适应证可以从骨干骨折进行延伸。 总之，半伸膝位关节外胫骨髓内钉技术较屈膝胫骨髓内钉技术有较多技术上的优势:术中可以更好的控制膝关节轴线;对同侧患者的合并损伤处置更方便;术中透视的时间更少等。 Tibial Nailing with the Knee Semi-Extended: Review of Techniques and Indications: AAOS Exhibit Selection. urban area 2.5.2 Yibin city in Yibin city, according to resource and environment characteristics Urban population and urban spatial distribution, spatial distribution of industries, major infrastructure Corridor layout, combined with the future development trend of synthetic judgments, planning, urban spatial structure of urban system can be summarized as: "a pole along the two axes". "A" refers to the metropolitan area along the Yangtze River, is the core area of the development of the city. Plans to build for the Yangtze River economic belt on the pillar, advancing along the ... Guanghe River, Yiliang, prestige of the external cohesion of zhaotong, Yunnan, internal connecting Yibin city to the North. The Sichuan-Yunnan-Guizhou border area of Yibin, in the city of zhaotong, liupanshui three, zhaotong city, the most populous and most extensive regions, the most economically backward, to the North in Wumeng mountain area of yanjin, shuifu, suijiang counties radiation power is relatively weak. Yibin city and infrastructure in such areas should be strengthened and docking, extending southward to public services, promote the development of mineral resources in Northeast Yunnan, expand our economic hinterland, driving synchronous lifting in Sichuan-Yunnan-Guizhou border area. This urban axis with mineral resource advantages, focus on the development of advanced technology, comprehensive utilization of resources of higher energy, new building materials, chemical industry, developing new energy and mining towns. Urban space organization-in gongxian County, Gao, junlian County Center for area organizations, improve, Gao, Gong, junlian County comprehensive services, and promoting regional economic development and population growth of the agglomeration. Along the main traffic arteries to implement "point-axis development" mode key repeatedly, Shahe town, Xiao Zhen, Luo table Zhen, Luo town, love Mu Zhen and other towns as district development focuses on cities and towns, promote the development of district