逆行髓内钉治疗股骨远端骨折的影响因素(英文)

Factors Affecting the Results of Distal Femoral Fractures Treated by Retrograde Intramedullary Nailing

目的探讨逆行髓内钉治疗股骨远端骨折的效果,并分析其影响因素。方法1999年11月-2006年6月,采用逆行髓内钉治疗股骨远端骨折30例(31侧)。男15例,女15例;年龄44～82岁,平均67.2岁。致伤原因:滑倒摔伤17例,交通伤11例,高处坠落伤2例。受伤至手术时间平均1.8d。按AO/OTA分型:A1型14侧,A2型7侧,A3型8侧,C1型2侧。股骨远端骨折线至髁间窝距离0～12cm,平均7.2cm。均行闭合逆行穿钉,未扩大髓内腔及植骨。结果手术时间45～110min,平均76min。患者均获随访,随访时间19～69个月,平均27个月。28侧骨折于术后12～22周愈合,平均14.7周。术后7例骨折出现并发症,其中3例A3型患者更换植入物或植骨;2例远端锁定螺钉松动,行再次固定;2例膝关节弯曲活动受限<90°。术后未出现深部感染、不良愈合成角>10°及患肢短缩>1cm。根据Schatzker-Lambert's评定标准,26侧骨折疗效满意,优良率84%。影响疗效的因素包括粉碎骨折及骨折位置(距髁间窝≤5cm)。其他可能影响因素包括年龄、螺钉类型及伴发伤。远端锁定螺钉的使用数量与疗效及其并发症无关(P>0.05)。结论逆行髓内钉可有效治疗股骨远端骨折,但应严格选择适应证,粉碎性骨折或近膝关节部位的骨折慎用。

Objective To assess the factors that affect the outcome of distal femoral fractures treated by retrograde intramedullary nailing. Methods Between November 1999 and June 2006, 30 patients with 31 distal femoral fractures （15 males and 15 females, 1 bilateral） were treated by retrograde nailing. Their ages ranged from 44 to 82 years old （average, 67.2 years old）. The causes of injury were slipping downs in 17 patients, traffic accidents in 11, and falling from height in 2. The average interval from injury to operation was 1.8 days. There were 14 cases of A1 fracture, 7 cases of A2, 8 cases of A3, and 2 cases of C1 according to AO/OTA classifications. The mean distance between the most distal line of the fracture and the in- tercondylar notch was 7.2 cm （range, 0-12 cm）. Closed retrograde nailing was done without reaming, and bone grafts were not done. Results The operation time averaged 76 minutes （range, 45-110 minutes）. All patients were followed up for 19-69 months, and the mean follow-up duration was 27 months. Twenty-eight of 31 fractures united on the average of 14.7 weeks （range, 12-22 weeks）. Complications occurred in 7 cases. There were 3 nonunions in AO-A3 fractures which were treated by changing implants or bone graft. Two patients suffered screw loosening of distal locking, that were re-fixed. Two patients showed limited knee motion of less than 90 degrees flexion. There were no cases of deep infection, malunion over 10 degrees of angulation or 1 cm of shortening. A satisfactory outcome （excellent and good results） was achieved in 26 of 31 cases （84%）, according to Schatzker and Lambert＇s criteria. Poor results and complications were related to fractures of comminution and located within 5 cm from the intercondylar notch （Pearson Chi-square test, P=0.03）. Other possible factors induding age, kinds of nails used, associated injury, and numbers of distal locking screws were not related to the outcome and complication （Pearson Chi-square test, P 〉 0.05）. Conclusion Retrograde nailing may be a useful option for distal femoral fractures, but attention should be paid to comminuted fractures or fractures close to the knee joint.