Stiletto R J, Baacke M
Klinik für Unfallchirurgie Klinik, Philipps-Universität Marburg, Baldinger Strasse, 35043 Marburg/Lahn.
Unfallchirurg. 2001 Aug;104(8):727-32. doi: 10.1007/s001130170074.
A total of 72 patients with femoral fractures was treated between July 1997 and November 1999, 41 of them with retrograde intramedullary fixation. A minimally invasive technique was performed in 18 cases using a recently designed retrograde dilatator system (RDS) for the insertion of ACE-nail (DePuy), the reaming of the femoral canal and the locking of the distal screws. The mean age of the 18 patients (7 men and 11 women) was 49 (+/- 21) years. 8 type A, 6 type B and 4 type C fractures of the femoral shaft according to the AO classification were observed. 5 of the patients had sustained a severe polytrauma. The mean ISS of the total collective was 18 (+/- 19). No nail failed, no infection occurred, and no nerve palsies were recorded. The follow-up time was 10 (+/- 7) months. All fractures healed uneventfully. 16 patients were mobilized under full weight-bearing and regained a full range of motion without pain. In 2 cases of very old patients nursing was possible without pain. In 5 cases an implant removal was carried out in the same technique. The performed minimally invasive technique using the RDS minimizes damages to the patella ligament and the articular cartilage. It facilitates the control of rotational deformities and length discrepancies of the femur also under difficult conditions, e.g. polytrauma and obese patients.
1997年7月至1999年11月期间，共治疗了72例股骨骨折患者，其中41例采用逆行髓内固定。18例采用微创技术，使用最近设计的逆行扩张系统（RDS）插入ACE钉（Depuy）、扩髓股骨髓腔并锁定远端螺钉。18例患者（7例男性和11例女性）的平均年龄为49（±21）岁。观察到8例A型、6例B型和4例C型股骨干骨折（根据AO分类）。5例患者遭受严重多发伤。全体患者的平均损伤严重度评分（ISS）为18（±19）。没有出现钉失败、感染，也没有记录到神经麻痹。随访时间为10（±7）个月。所有骨折均顺利愈合。16例患者可完全负重活动，恢复了全范围无痛活动。2例高龄患者可无痛护理。5例患者采用相同技术取出植入物。使用RDS进行的微创技术将对髌韧带和关节软骨的损伤降至最低。即使在困难情况下，如多发伤和肥胖患者，它也有助于控制股骨的旋转畸形和长度差异。
