股骨干骨折带锁髓内针固定后骨折端旋转畸形的测量

Measurement of fracture malrotation after interlocking intramedullary nailing of femoral shaft fracture

目的 对股骨干骨折带锁髓内针固定后旋转畸形的程度进行定量测定 ,以纠正旋转对位 ,减少其发生率和严重程度。方法 采用CT扫描 (“常用法”)测量 3 6例以闭合复位、带锁髓内针固定治疗的股骨干骨折患者的双侧前倾角 ,计算双侧的差值 ,用来判断骨折远近端旋转畸形的程度。前倾角增大表明远骨折端内旋 ,前倾角减小则代表远骨折端外旋。结果 患侧组前倾角值为 ( 15 0 4±11 3 4 )° ,最大值为 4 8° ,最小值为 - 10° ;健侧组前倾角值为 ( 13 96± 10 2 0 )° ,最大值为 3 1 3 0°,最小值为- 4 8° ,使用配对资料t检验 ,P <0 0 0 1,差异有非常显著性的意义。其中差值最大为 3 7° ,最小为0 90° ,平均相差 10 4 8°。患侧与健侧相比前倾角增大 (远骨折端内旋 )与减小 (远骨折端外旋 )各有 18例 ;而其中内旋者平均为 11 5 6°,外旋者平均为 9 3 9°。内旋小于 10°者有 8例 ,10°至 15°者有 6例 ,大于15°者有 4例 ;外旋小于 10°者有 11例 ,10°至 15°者有 4例 ,大于 15°者有 3例。超过 10°的旋转对位发生率是 4 7% ( 17/ 3 6) ,超过 15°者有 7例 ( 19 4 % )。结论 股骨干骨折采取闭合复位带锁髓内针治疗后旋转畸形的发生率较高 ,临床上应予重视。术中应在影像监视器监控下严格纠正旋转对?

Objective To study the quantitative measurement of the extent of malrotation after interlocking intramedullary nailing of femoral shaft fracture. Methods CT scan ('routine method') was applied in 36 femoral shaft fractures that had been treated with close reduction and interlocking intramedullary nailing. For the judgement of the extent of malrotation, the anteversion of both fracture side and contralateral side were measured and the difference between the 2 sides was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion represented external rotation. Results The maximum anteversion of the fracture sides was 48°, the minimum anteversion -10°, the mean value 15 04°, and the standard error 11 34°. The maximum anteversion of the contralateral side was 31 30°, the minimum -4 80°, the mean value 13 96° and the standard error 10 20°( P <0 001). Compared with the contralateral side, half of the 36 cases showed increased anteversion and the other half decreased anteversion. The mean value of internal rotation was 11 56°, and external rotation 9 39°. The maximum internal rotation was 37°, the minimum 0 9°. Eight cases had internal rotation less than 8°,6 between 10°-15°,and 4 over 15°. The maximum external rotation was 24 3°, and the minimum 1 8°. Eleven cases had external rotation less than 10°,4 between 10°-15° and 3 over 15°.The incidence of malrotation more than 10° was 47%(17/36), and more than 15° 19 4%(7/36). Conclusion The incidence of malrotation after femoral shaft fracture treated with close reduction and interlocking intramedullary nailing is high. Attention should be paid to clinical management and strict control for rotational reduction intraoperatively.