Renner N L, Zych G A
Allgemeinchirurgische Klinik, Departement Chirurgie, Kantonsspital Basel.
Helv Chir Acta. 1992 Mar;58(5):683-6.
35 consecutive cases of fractures of the femoral diaphysis due to gunshot wounds (GSW) treated at Jackson Memorial Hospital of the University of Miami between January 1988 and February 1990 were reviewed. There were 32 low velocity and 3 high energy transfer wounds. The treatment protocol for low velocity GSW consisted of 3 days i.v. antibiotics, balanced skeletal traction (for logistic reasons) and delayed closed intramedullary nailing. There was no formal debridement performed. 3 out of 32 patients declined any operative intervention. The remaining 29 patients were treated according to the above protocol. 12 patients could be followed until complete osseous consolidation. In this group the only complication consisted of one late infection. 17 patients were lost to follow-up before complete consolidation. Out of this group, 8 showed advanced fracture callus formation on the last radiograph available, whereas 9 patients were lost to follow-up almost immediately after discharge. Since GSW victims were generally uninjured and treatment of indigent patients in the Miami area is declined by all other hospitals, we assume that there were non major complications even in the group of patients lost to follow-up. We therefore conclude, that intramedullary nailing of low velocity gunshot fractures of the femoral diaphysis without formal debridement is the treatment of choice under civilian circumstances.
回顾了1988年1月至1990年2月间在迈阿密大学杰克逊纪念医院接受治疗的35例因枪伤导致的股骨干骨折病例。其中有32例低速枪伤和3例高能传递伤。低速枪伤的治疗方案包括静脉注射抗生素3天、平衡骨牵引（出于后勤原因）以及延迟闭合髓内钉固定。未进行正式的清创术。32例患者中有3例拒绝任何手术干预。其余29例患者按照上述方案进行治疗。12例患者可随访至骨完全愈合。在该组中，唯一的并发症为1例晚期感染。17例患者在骨完全愈合前失访。在这组患者中，8例在最后一次可获得的X线片上显示有骨折痂形成，而9例患者在出院后几乎立即失访。由于枪伤受害者通常无其他损伤，且迈阿密地区的其他医院均拒绝接收贫困患者进行治疗，我们推测即使在失访患者组中也无重大并发症。因此，我们得出结论，在民用情况下，对于股骨干低速枪伤骨折，不进行正式清创的髓内钉固定是首选治疗方法。
