由内向外芯钻髓内钉技术治疗股骨干骨折

Core drilling intramedullary nail with inside-out technique for femoral shaft fracture

[目的]探讨由内向外芯钻髓内钉配合改良芯钻远端锁定技术治疗股骨干骨折的临床疗效。[方法]回顾分析本院2014年8月~2016年10月106例股骨干骨折行芯钻髓内钉治疗患者的临床资料,其中前30例为前期组,后30例为后期组,术后观察并比较两组的手术时间、出血量、远端置钉一次成功率、透视次数、下地时间和术中并发症发生率。[结果]前期组手术时间明显长、出血量明显多于后期组,差异具有统计学意义(P<0.05)。前期组远端置钉一次成功率显著低于后期组,两组差异具有统计学意义(46.67%vs 93.33%,P<0.05)。前期组透视次数显著多于后期组,差异具有统计学意义[(7.23±2.27)次vs(3.34±1.75)次,P<0.05]。前期组下地时间显著长于后期组,差异有统计学意义[(17.69±5.44)d vs(10.22±3.74)d,P<0.05]。前期组出现芯钻打折6例,芯钻断裂5例,后期组仅出现芯钻断裂1例,差异具有统计学意义(P<0.05)。60例患者随访(14.32±4.78)个月,骨折平均愈合时间(17.41±4.81)周,末次随访时,所有患者均获得满意的功能恢复。[结论]芯钻髓内钉配合改良远端锁定技术治疗股骨干骨折能减少手术创伤、远端快速锁定、明显降低透视次数及并发症,但此技术有一定的学习曲线。

[Objective] To evaluate the clinical outcomes of femoral shaft fracture treated with inside-out core drilling intramedullary nail and modified distal locking technique. [Methods] From August 2014 to October 2016, 106 patients with femoral shaft fractures were treated with core drilling intramedullary nail. Of them, the first 30 patients were termed as the early group, whereas the latter 30 patients were named as the late group according to the sequence of operation performed. The operation time, the blood loss, the first success rate of the distal locking screw placement, the frequency of radiographic exposure, intraoperative complications and ambulation time were compared between the two groups. [Results] The early group consumed significantly longer operation time, associated with significantly more blood loss than the late group with statistical significance（P〈0.05）. Regarding to the first success rate of the distal locking screw insertion, the early group was significantly inferior to the late group（46.67% versus 93.33%, P0.05）. In addition, the early group took significant greater frequency of radiographic exposure than the late group [（7.23±2.27） times versus（3.34±1.75） times, P0.05]. Furthermore, the early group took significantly more time to return ambulation than the late group [（17.69±5.44） days versus（10.22±3.74） days, P〈0.05]. In term of complication, 6 cases of core drill bent and 5 cases of core drill broken were noted in the early group, while only 1 cases of core drill broken occurred in the late group, where was statistically significant（P〈0.05）. All the patients were followed up for an average of（14.32±4.78） months. Bony healing achieved at（17.41±4.81） weeks on average, additionally, satisfactory functional recovery realized in all patients at the latest follow up. [Conclusion]The core drilling intramedullary nail with modified distal locking technique for femoral shaft fracture does got satisfactory clinical consequences with advantages of reducing surgical trauma, accelerating the distal locking, however, it requires a bit of a learning curve.