Grass R, Biewener A, Rammelt S, Zwipp H
Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinkum C.G. Carus, Technischen Universität, Fetscherstrasse 74, 01307 Dresden.
Unfallchirurg. 2002 Apr;105(4):298-314. doi: 10.1007/s00113-002-0442-3.
Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.
20世纪60年代末，采用固定或等长牵引的非手术治疗方法已被摒弃，不再用于治疗股骨远端骨折。自20世纪70年代以来，AO所倡导的采用髁钢板进行切开复位内固定技术一直是金标准。然而，采用骨折块间螺钉固定对髁部区域进行解剖重建以及用钢板对股骨干进行轴向复位是具有挑战性的操作，尤其是在软组织严重受损的情况下，并且会危及骨膜血供。软组织并发症、轴向畸形和骨折愈合时间延迟促使人们考虑采用替代技术，比如髓内钉固定术。自20世纪40年代以来，格哈德·昆茨舍尔及其同事成功地将髓内钉固定术用于股骨干骨折，其并发症发生率极低，闭合复位后效果更佳。股骨逆行髓内钉时代始于格林通过髁间切迹的系统方法。本文回顾了AO“股骨远端髓内钉”（DFN）治疗骨折的生物力学特性、适应证、技术以及潜在风险和陷阱。通过适当应用，该技术适用于股骨干远端三分之一的所有骨折，包括高度不稳定的双髁骨折，且不会损伤软组织和膝关节。
