髓内钉治疗股骨干骨折治疗策略临床回顾

Retrospective strategies for intramedullary nailing in the treatment of femoral shaft fractures

目的:回顾性分析股骨干骨折髓内钉固定术前、术中和术后特点,为临床提供参考。方法:回顾性分析南方医科大学附属南方医院120例股骨干骨折髓内钉固定术前特点及术后并发症等指标,包括病例特点、骨折类型、手术时间、损伤评分、髓内钉类型、手术方法,术后并发症例如感染、股骨颈骨折等指标。结果:大部分手术采用仰卧位(82.5%)、牵引床牵引(57.1%)和顺行固定技术(84.5%)。有59.2%病例为单纯性股骨干骨折,剩余为复合型多发伤,复合型伤和伴有严重胸椎骨折患者手术一般采取延期髓内钉治疗,38.0%的复合严重胸椎损伤的患者一般在创伤后第1天进行髓内钉手术,髓内钉并发症的发生率较低,但是股骨颈骨折发生率较高。结论:大部分股骨干骨折患者髓内钉固定术采用仰卧位顺行植入髓内钉,并发症的发生率较低;对于多发性创伤的患者,需要在创伤后1 d内及时进行髓内钉固定术。

Objective： To retrospective determine current techniques and perioperative complications of intramedullary nailing of diaphyseal femoral fractures.Methods： 120 cases of diaphyseal femoral fractures were collected.Information about fracture classification,time to operation,injury severity score,type of nail,and operative technique,as well as perioperative complications such as infection,femoral neck fracture were selected.Results： The preferred position for implantation was supine（82.5%）.Most surgeons used a traction table（57.1%） and an antegrade implantation technique（84.5%）.In 59.2% of the cases,an isolated femur fracture was present,while the rest sustained multiple injuries.In polytrauma patients and patients with severe thorax injuries,most surgeons were chosed a delayed treatment with intramedullary femoral nails.Interestingly,38.0% of the patients with severe thorax injuries were treated on the first day with intramedullary femoral nails.The total rate of complications for intramedullary femoral nailing was low,but a high rate of intraoperative femoral neck fractures was observed.Conclusion： The vast majority of surgeons prefer the supine position and the antegrade technique to implant intramedullary femoral nails.The incidence rate of complication is low;A large number of polytrauma patients and patients with severe thoracic trauma are treated with intramedullary femoral nails on the first day of trauma.