Gebhard F, Pokar S, Hehl G, Strecker W, Kinzl L, Arand M
Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie, Universität Ulm.
Unfallchirurg. 2000 Dec;103(12):1116-20. doi: 10.1007/s001130050676.
Recently, the retrograde femoral nailing has become a procedure with increasing acceptance. Indications for the retrograde femur nail are distal femoral fractures including dia- and transcondylar fractures, supracondylar osteotomies and distal periprosthetic femur fractures after total knee joint replacement. Controversial discussion is carried on about the implant removal, which is potentially afflicted with further damage to the knee joint. To minimize the operative damage due to the implant removal, an arthroscopic assisted procedure has been selected. The arthroscopic assisted implant removal was possible in all of our patients. Intraoperatively, 2/3 of the patients showed normal age-related findings of the chondral and meniscal structures. The arthroscopic assisted implant removal is a gentle procedure, which allows minimal invasive extraction of retrograde femur nails and prevents secondary damage to the knee joint due to the otherwise difficult localisation of the implant. The advantages of this procedure concerning gentleness and diagnostic capabilities are as convincing, that we indicate implant removal of retrograde femur nails in all younger patients (< 60 years), except in periprosthetic fractures.
最近，逆行股骨交锁髓内钉已成为一种越来越被接受的手术方式。逆行股骨交锁髓内钉的适应证包括股骨远端骨折，如髁间和髁上骨折、髁上截骨以及全膝关节置换术后股骨假体周围远端骨折。关于取出内固定装置存在争议性讨论，因为这可能会对膝关节造成进一步损伤。为了将取出内固定装置导致的手术损伤降至最低，我们选择了关节镜辅助手术。在我们所有患者中，关节镜辅助下取出内固定装置均可行。术中，2/3的患者显示出与年龄相关的软骨和半月板结构正常表现。关节镜辅助下取出内固定装置是一种温和的手术方式，它允许以微创方式取出逆行股骨交锁髓内钉，并防止因内固定装置定位困难而对膝关节造成继发性损伤。该手术方式在温和性和诊断能力方面的优势令人信服，以至于我们建议在所有年轻患者（<60岁）中取出逆行股骨交锁髓内钉，但假体周围骨折患者除外。
