Anup Khare, Mehra M M
S R Hospital, AGRA, India.
J Orthop Surg (Hong Kong). 2002 Jun;10(1):17-21. doi: 10.1177/230949900201000104.
Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur. This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture. The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90 degrees of movement, these were old fractures and non-cooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil. Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is economical also.
逆行交锁髓内钉被用作35例不同类型复杂股骨骨折合并伤的固定方法。我们在股骨干骨折合并股骨颈骨折、股骨近端三分之一病理性骨折合并转子病变、多发伤合并其他多处损伤的同侧股骨和胫骨骨折、高度肥胖患者的股骨干骨折中采用了该手术方法。该技术还用于妊娠合并股骨干骨折的病例以及不稳定骨盆骨折或髋关节脱位合并股骨干骨折的病例。手术技术包括通过髁间切迹的入口逆行插入未扩髓、非空心的定制髓内钉来固定股骨干骨折。髋部周围的其他相关骨折根据骨折类型使用合适的植入物单独固定。在同侧股骨和胫骨骨折的病例中，通过相同切口在同一次手术中用逆行交锁髓内钉固定股骨，用顺行交锁髓内钉固定胫骨。对这些病例进行了三年的随访；平均愈合时间为12至18周。35例病例中，31例膝关节恢复了完全活动。其余4例中，2例恢复了高达90度的活动度，这些是陈旧性骨折和不配合的患者。有1例因手术失误导致髌股关节炎，当时髓内钉未置于关节面内。在该系列的早期病例中观察到了畸形愈合，未出现植入物失败的情况。逆行交锁髓内钉被用作复杂骨折问题的固定方法。长骨的多处骨折可以一期固定，避免了多发伤患者在不同阶段进行多次手术。这使得患者能够早期康复，住院时间缩短，康复早，效果良好，而且经济实惠。
