逆行和顺行髓内钉治疗股骨干中段骨折的研究

Retrograde and anterograde intramedullary nailing in treating midshaft fracture of femoral shaft

目的 观察逆行股骨髓内钉和顺行股骨髓内钉治疗股骨干中段骨折的疗效和并发症。方法 选取股骨干中段骨折患者76例纳入本研究,根据主钉置入方式的不同,分为逆行组36例和顺行组40例。比较2组围术期、随访及并发症情况。结果 2组患者髓内钉直径、透视次数、骨折两端螺钉数量比较,差异无统计学意义(P>0.05);逆行组手术时间短于顺行组,而出血量多于顺行组,差异有统计学意义(P<0.05)。末次随访时2组患者骨折愈合时间、Harris评分、Lysholm评分、骨折愈合率比较,差异无统计学意义(P>0.05)。顺行组膝关节屈曲度为(130.22±4.31)°,优于逆行组的(126.58±8.41)°,逆行组患者膝关节疼痛发生率(19.4%)高于顺行组(2.5%),差异有统计学意义(P<0.05)。结论 逆行髓内钉和顺行髓内钉治疗股骨干中段骨折均可取得较满意的临床疗效,逆行置钉无需牵引床,相对便捷,但逆行钉固定后膝关节并发症相对较多。

Objective To observe the efficacy and complications of retrograde femoral intramedullary nailing and anterograde femoral intramedullary nailing in the treatment of midshaft fracture of femoral shaft.Methods A total of 76 patients with middle femoral shaft fracture were included in this study.According to the different placement methods of main screws,they were divided into retrograde group(36 cases) and anterograde group(40 cases).The conditions of perioperation,during follow-up and occurrence of complications of the two groups were compared.Results There were no significant differences in diameter of intramedullary nail,the number of fluoroscopy,the number of screws at both ends of fracture between the two groups(P>0.05).In the retrograde group,the operation time was shorter than that in the anterograde group,and amount of bleeding was more than that in the anterograde group(P0.05).The knee flexion degree in the anterograde group was(130.22±4.31)°,which was better than(126.58±8.41)° in the retrograde group,and the incidence of knee pain in the retrograde group was 19.4%,which was significantly higher than 2.5% in the anterograde group(P<0.05).Conclusion Both retrograde intramedullary nail and anterograde intramedullary nail can achieve satisfactory clinical effects in the treatment of middle femoral shaft fractures.Retrograde nail placement is relatively convenient without traction bed,but there are relatively more complications in knee joint after retrograde nail fixation.