Hartin Nathan L, Harris Ian, Hazratwala Kaushik
Department of Orthopaedics, Liverpool Hospital, Liverpool, New South Wales, Australia.
ANZ J Surg. 2006 May;76(5):290-4. doi: 10.1111/j.1445-2197.2006.03714.x.
A variety of devices have been used in the treatment of supracondylar femoral fractures. The condylar blade plate relies on the principles of open reduction, absolute stability and interfragmentary compression to achieve union. The technique of retrograde nailing uses indirect reduction of the metaphyseal fracture component, offering relative stability and a less invasive approach. Randomized comparison of these common methods of fixation has not been reported.
Twenty-two patients with 23 supracondylar femur fractures were recruited from two regional trauma centres over a 26-month period and randomized to receive either a retrograde intramedullary nail fixation (IM group, 12 fractures) or a fixed-angle blade plate fixation (BP group, 11 fractures). The groups were followed for 12-36 months. The primary outcome measures were revision surgery and general health.
Three patients in the IM group required revision surgery for the removal of implant components. No reoperations occurred in the BP group. There was a trend towards greater pain in the IM group, although there was no statistically significant difference in the scores for any of the SF-36 domains.
Both distal femoral nailing and blade plating give good outcomes. There is a trend for patients undergoing retrograde nailing to complain of more pain and to require revision surgery for removal of implants.
多种器械已用于股骨髁上骨折的治疗。髁钢板依靠切开复位、绝对稳定和骨折块间加压的原则来实现骨折愈合。逆行髓内钉技术采用间接复位干骺端骨折部分，提供相对稳定性且手术创伤较小。尚未见这些常用固定方法的随机对照比较报道。
在26个月期间，从两个地区创伤中心招募了22例患有23处股骨髁上骨折的患者，并随机分为接受逆行髓内钉固定（IM组，12处骨折）或角钢板固定（BP组，11处骨折）。对两组进行了12至36个月的随访。主要结局指标为翻修手术和总体健康状况。
IM组有3例患者因取出植入物部件而需要进行翻修手术。BP组未发生再次手术。IM组有疼痛加剧的趋势，尽管在SF-36各领域的评分中无统计学显著差异。
股骨远端髓内钉固定和钢板固定均能取得良好疗效。接受逆行髓内钉固定的患者有抱怨疼痛更多且需要进行翻修手术取出植入物的趋势。
