Shepherd L E, Shean C J, Gelalis I D, Lee J, Carter V S
Los Angeles County/University of Southern California Medical Center, Department of Orthopedic Surgery, University of Southern California, Los Angeles, USA.
J Orthop Trauma. 2001 Jan;15(1):28-32; discussion 32-3. doi: 10.1097/00005131-200101000-00005.
To determine whether the procedure of unreamed femoral nailing is simpler, faster, and safer than reamed femoral intramedullary nailing.
Prospective randomized.
SETTING/PARTICIPANTS: One hundred femoral shaft fractures without significant concomitant injuries admitted to an academic Level 1 urban trauma center.
Stabilization of the femoral shaft fracture using a reamed or unreamed technique.
The surgical time, estimated blood loss, fluoroscopy time, and perioperative complications were prospectively recorded.
One hundred patients with 100 femoral shaft fractures were correctly prospectively randomized to the study. Thirty-seven patients received reamed and sixty-three patients received unreamed nails. All nails were interlocked proximally and distally. The average surgical time for the reamed nail group was 138 minutes and for unreamed nail group was 108 minutes (p = 0.012). The estimated blood loss for the reamed nail group was 278 milliliters and for the unreamed nail group 186 milliliters (p = 0.034). Reamed intramedullary nailing required an average of 4.72 minutes, whereas unreamed nailing required 4.29 minutes of fluoroscopy time. Seven perioperative complications occurred in the reamed nail group and eighteen in the unreamed nail group. Two patients in the unreamed group required an early secondary procedure. Iatrogenic comminution of the fracture site occurred during three reamed and six unreamed intramedullary nailings. Reaming of the canal was required before the successful placement of three nails in the unreamed group because of canal/nail diameter mismatch.
Unreamed femoral intramedullary nailing involves fewer steps and is significantly faster with less intraoperative blood loss than reamed intramedullary nailing. The unreamed technique, however, was associated with a higher incidence of perioperative complications, although the difference was not statistically significant (p = 0.5).
确定非扩髓股骨钉固定术是否比扩髓股骨髓内钉固定术更简单、快速且安全。
前瞻性随机对照研究。
地点/参与者：100例股骨干骨折且无严重合并伤的患者，均入住一家一级城市创伤学术中心。
采用扩髓或非扩髓技术对股骨干骨折进行固定。
前瞻性记录手术时间、估计失血量、透视时间及围手术期并发症。
100例股骨干骨折患者被正确地前瞻性随机分组纳入研究。37例患者接受扩髓钉固定，63例患者接受非扩髓钉固定。所有钉子均在近端和远端进行锁定。扩髓钉组平均手术时间为138分钟，非扩髓钉组为108分钟（p = 0.012）。扩髓钉组估计失血量为278毫升，非扩髓钉组为186毫升（p = 0.034）。扩髓髓内钉固定平均需要透视时间4.72分钟，而非扩髓钉固定需要4.29分钟。扩髓钉组发生7例围手术期并发症，非扩髓钉组发生18例。非扩髓组有2例患者需要早期二次手术。在3例扩髓和6例非扩髓髓内钉固定术中发生了骨折部位的医源性粉碎。由于髓腔/钉子直径不匹配，非扩髓组有3枚钉子在成功置入前需要扩髓。
非扩髓股骨髓内钉固定术步骤更少，与扩髓髓内钉固定术相比，手术速度明显更快，术中失血量更少。然而，非扩髓技术围手术期并发症发生率较高，尽管差异无统计学意义（p = 0.5）。
