Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.
Clin Orthop Surg. 2009 Dec;1(4):201-6. doi: 10.4055/cios.2009.1.4.201. Epub 2009 Nov 25.
Periprosthetic supracondylar fractures of the femur after total knee arthroplasty are not common but are usually difficult to treat due to the advanced age of patients and frequently accompanying osteoporosis. Retrograde intramedullary nailing can be effective in promoting healing of these fractures by providing sufficient stability, but the number of beneficiaries is small due to its limited applicability and the postoperative function has rarely been assessed. This study evaluated the efficacy of retrograde intramedullary nailing for the treatment of periprosthetic supracondylar fractures of the femur using the clinical outcomes.
Between January 2000 and May 2006, 9 patients (10 knees) with periprosthetic supracondylar fractures of the femur underwent retrograde intramedullary nailing. An open reduction and additional fixation using a shape memory alloy ring were used in 3 of them in whom a closed reduction was not successful. The clinical and radiographic findings were reviewed retrospectively in 7 patients (8 knees), excluding 2 who were unavailable for a follow-up assessment due to death. The mean follow-up period was 39 months (range, 24 to 82 months). The union and alignment of the fracture were assessed radiographically. The postoperative function was evaluated using Sanders' criteria.
Radiographic union was obtained in all patients after an average of 13 weeks (range, 12 to 15 weeks) postoperatively. No postoperative infection, heterotopic ossification and component loosening were observed. After union, the coronal alignment averaged 0.1 degrees valgus (range, 3.6 degrees varus to 2.6 degrees valgus) and the mean sagittal alignment was 1.9 degrees of extension (range, 0.9 degrees of flexion to 6.3 degrees of extension). The mean range of motion was 103 degrees (range, 90 degrees to 120 degrees) postoperatively. At the last follow up, there were 1 excellent, 5 good and 2 fair results according to Sanders' criteria.
With retrograde intramedullary nailing, excellent fracture union and good functional recovery were obtained in patients with periprosthetic supracondylar fractures.
全膝关节置换术后股骨髁上周围骨折并不常见，但由于患者年龄较大且常伴有骨质疏松症，通常难以治疗。逆行髓内钉固定可通过提供足够的稳定性有效促进骨折愈合，但由于其适用性有限，受益人数较少，且术后功能很少得到评估。本研究通过临床结果评估逆行髓内钉治疗股骨髁上周围骨折的疗效。
2000 年 1 月至 2006 年 5 月，9 例（10 膝）股骨髁上周围骨折患者接受逆行髓内钉治疗。其中 3 例闭合复位不成功者采用切开复位及形状记忆合金环附加固定。回顾性分析 7 例（8 膝）患者的临床和影像学资料，排除 2 例因死亡无法进行随访评估的患者。平均随访时间为 39 个月（范围，24 至 82 个月）。评估骨折的愈合和对线。采用 Sanders 标准评估术后功能。
所有患者术后平均 13 周（范围，12 至 15 周）获得影像学愈合。无术后感染、异位骨化和假体松动。愈合后冠状面平均外翻 0.1 度（范围，内翻 3.6 度至外翻 2.6 度），矢状面平均伸展 1.9 度（范围，屈曲 0.9 度至伸展 6.3 度）。术后平均活动度为 103 度（范围，90 度至 120 度）。末次随访时，根据 Sanders 标准，1 例为优，5 例为良，2 例为可。
逆行髓内钉治疗股骨髁上周围骨折可获得良好的骨折愈合和功能恢复。
