Ostrum R F
Grant Medical Center, Columbus, OH, USA.
Clin Orthop Relat Res. 2000 Jun(375):43-50. doi: 10.1097/00003086-200006000-00006.
The current study is a review of 20 patients treated by percutaneous stabilization for a floating knee. All patients were treated with a retrograde femoral intramedullary nail and a small diameter tibial intramedullary nail through a 4-cm medial parapatellar tendon incision. The average Injury Severity Score was 19. Two patients died in the early postoperative period and one patient was lost to followup. The average time to union for the 17 remaining patients with femoral shaft fractures was 14.7 weeks. One patient required dynamization. Four of the 17 patients with tibia fractures required an exchange nailing procedure, one with bone graft, to achieve union. One patient required dynamization and one patient with bone loss required only a bone graft. The average time to union for the tibia fractures was 23 weeks. One patient achieved 115 degrees knee flexion and the remaining 15 patients had full knee motion by 12 weeks, which they were able to maintain. No patient had signs or symptoms of knee pain. This demanding surgical technique using a small incision has yielded good clinical results. Although it is an excellent treatment option for patients with ipsilateral femoral and tibial shaft fractures, the mortality and tibial fracture complication rates remain high.
本研究回顾了20例采用经皮固定治疗浮动膝的患者。所有患者均通过4厘米的内侧髌旁腱切口，采用逆行股骨髓内钉和小直径胫骨髓内钉进行治疗。平均损伤严重度评分是19分。两名患者在术后早期死亡，一名患者失访。其余17例股骨干骨折患者的平均愈合时间为14.7周。一名患者需要动力化。17例胫骨骨折患者中有4例需要更换髓内钉手术，其中1例需要植骨以实现愈合。一名患者需要动力化，一名骨缺损患者仅需植骨。胫骨骨折的平均愈合时间为23周。一名患者膝关节屈曲达到115度，其余15例患者在12周时膝关节活动度完全恢复，并得以维持。没有患者出现膝关节疼痛的体征或症状。这种采用小切口的高要求手术技术取得了良好的临床效果。尽管它对于同侧股骨干和胫骨干骨折患者是一种极佳的治疗选择，但死亡率和胫骨骨折并发症发生率仍然很高。
