新型股骨撑开复位装置在股骨干骨折闭合复位顺行髓内钉固定术中的应用

A new femoral distractor used in close reduction and internal fixation with antegrade intramedullary nail for femoral shaft fractures

目的探讨自行研制的新型股骨撑开复位装置在股骨干骨折闭合复位顺行髓内钉固定术中的应用效果。方法回顾性分析2010年9月至2015年3月期间应用自行研制的新型股骨骨折撑开复位装置闭合复位顺行髓内钉固定治疗的85例股骨干骨折患者资料。男64例，女21例；平均年龄为36．6岁。骨折AO分型：32-A型32例，32-B型40例，32-C型13例。受伤至手术时间平均为7．5d（1-16d）。股骨上段骨折26例，股骨中段骨折57例，股骨中段骨折合并股骨颈骨折1例，股骨下段骨折合并股骨转子间骨折1例。记录患者的手术时间、术中出血量、骨折愈合时间、术中及术后并发症的发生情况等。结果85例患者均成功实现骨折闭合复位，术中未损伤重要血管、神经。本组患者的手术时间平均为105．5min，术中X线曝光时间平均为25．8s，术中出血量平均为209．2mL。85例患者术后获8-24个月（平均16．3个月）随访。2例患者骨折不愈合；其余83例患者骨折均获愈合，愈合时间平均为7．8周（4-12周）。术后1年随访所有患者患侧膝关节功能恢复正常，无肢体短缩〉10mm及旋转成角〉15。畸形发生，无侧方及前后成角〉10。畸形发生。随访期间无一例患者发生伤口感染、深静脉血栓形成及肺栓塞等并发症。结论在新型股骨撑开复位装置的辅助下，比较容易实现股骨干骨折闭合复位顺行髓内钉固定，避免了应用牵引床复位的不便及潜在并发症。

Objective To introduce a novel femoral distractor which is applied in close reduction and internal fixation （CRIF） with antegrade intramedullary nail for femoral shaft fractures. Methods From September 2010 to March 2015, 85 patients with femoral shaft fracture were treated by CRIF with antegrade intramedullary nail in which our self-designed novel distractor was used. They were 64 males and 21 females, with an average age of 36.6 years. By AO classification, we had 32 cases of type 32-A, 40 cases of type 32-B, and 13 cases of type 32-C. The intervals between injury and surgery averaged 7.5 days （range, from 1 to 16 days） . The fracture was located at the upper shaft in 26 cases, at the middle shaft in 57 cases, at the middle shaft and ipsilateral neck in one, and at the lower shaft and ipsilateral intertrochanteric site in one. Their op- eration time, intraoperative blood loss, intra- and post-operative complications, and fracture union time were recorded and analyzed. Results Successful close reduction was achieved in all the 85 patients with no ia- trogenie injury to major vessels or nerves. Operation time averaged 105.5 minutes; time for X-ray exposure av- eraged 25.8 seconds; intraoperative blood loss averaged 209.2 mL . The 85 patients received follow-ups from 8 to 24 months （mean, 16.3 months）. Fracture union was achieved in 83 cases after an average duration of 7.8 weeks （range, from 4 to 12 weeks）, but nonunion occurred in 2 cases. One-year follow-ups revealed recovery of normal function of the affected knee in all, with no limb shortening 〉 10 mm, rotational augulation 〉 15°, or lateral or auteroposterior angulation 〉 10°. No incision infection, deep vein thrombosis or pulmonary embolism happened during the entire follow-up. Conclusion Our self-designed novel distractor can facilitate CRIF with antegrade intramedullary nail for femoral shaft fractures, and avoid the complications and inconvenience associated with a traction table.