van Eerten P V, Reemst P H M, Repelaer van Driel O J
Trauma Department, Maxima Medical Center, P.O. Box 90052, 5600 PD Eindhoven, The Netherlands.
Arch Orthop Trauma Surg. 2005 Apr;125(3):197-200. doi: 10.1007/s00402-005-0799-1. Epub 2005 Feb 19.
Case report about a minimally invasive technique for removal of a femoral antegrade nail (FAN). Femoral nails are introduced by minimally invasive techniques, but are often removed with more invasive surgery.
Four cases of young patients are described in whom the femoral nail was removed after consolidation by a minimally invasive extraction technique at the trochanteric site. By using a threaded wire for locating the proximal entrance of the femoral nail followed by reaming over the wire, the entrance of the nail in the trochanteric region is freed. Then the extraction bolt can be placed over the wire and the nail can be extracted through the same incision as it was inserted in, without enlarging the incision.
This case report discusses a technique for minimally invasive femoral nail extraction, not the necessity of removing nails. Leaving out the endcap at the initial operation is the only preoperative condition, since the endcap blocks the entrance of the nail. This operation is done with fluoroscopic guidance. The difficult part is the reaming. The reamer must not be damaged when approaching the nail entrance. This minimally invasive femoral nail extraction technique is applicable for various types of femoral nails.
Minimally invasive extraction of femoral nails is possible and needs more attention. The level of evidence is a level IV case series.
关于一种微创取出股骨顺行髓内钉（FAN）技术的病例报告。股骨髓内钉通过微创技术置入，但通常需采用更具侵入性的手术取出。
描述了4例年轻患者，在骨折愈合后通过微创技术在转子部位取出股骨髓内钉。使用螺纹导丝定位股骨髓内钉的近端入口，然后沿导丝扩孔，使髓内钉在转子区域的入口得以游离。接着可将取出螺栓置于导丝上，通过与置入髓内钉相同的切口取出髓内钉，无需扩大切口。
本病例报告讨论的是微创取出股骨髓内钉的技术，而非取出髓内钉的必要性。初始手术时不安装尾帽是唯一的术前条件，因为尾帽会阻塞髓内钉入口。该手术在透视引导下进行。难点在于扩孔。扩孔钻接近髓内钉入口时不能受损。这种微创取出股骨髓内钉的技术适用于各种类型的股骨髓内钉。
股骨髓内钉的微创取出是可行的，且需要更多关注。证据级别为IV级病例系列。
