Kim Joon-Woo, Oh Chang-Wug, Kyung Hee-Ssoo, Min Woo-Kie, Yoon Sang-Hyup
Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Nov;23(11):1311-5.
To assess the factors that affect the outcome of distal femoral fractures treated by retrograde intramedullary nailing.
Between November 1999 and June 2006, 30 patients with 31 distal femoral fractures (15 males and 15 females, 1 bilateral) were treated by retrograde nailing. Their ages ranged from 44 to 82 years old (average, 67.2 years old). The causes of injury were slipping downs in 17 patients, traffic accidents in 11, and falling from height in 2. The average interval from injury to operation was 1.8 days. There were 14 cases of A1 fracture, 7 cases of A2, 8 cases of A3, and 2 cases of C1 according to AO/OTA classifications. The mean distance between the most distal line of the fracture and the intercondylar notch was 7.2 cm (range, 0-12 cm). Closed retrograde nailing was done without reaming, and bone grafts were not done.
The operation time averaged 76 minutes (range, 45-110 minutes). All patients were followed up for 19-69 months, and the mean follow-up duration was 27 months. Twenty-eight of 31 fractures united on the average of 14.7 weeks (range, 12-22 weeks). Complications occurred in 7 cases. There were 3 nonunions in AO-A3 fractures which were treated by changing implants or bone graft. Two patients suffered screw loosening of distal locking, that were re-fixed. Two patients showed limited knee motion of less than 90 degrees flexion. There were no cases of deep infection, malunion over 10 degrees of angulation or 1 cm of shortening. A satisfactory outcome (excellent and good results) was achieved in 26 of 31 cases (84%), according to Schatzker and Lambert's criteria. Poor results and complications were related to fractures of comminution and located within 5 cm from the intercondylar notch (Pearson Chi-square test, P = 0.03). Other possible factors including age, kinds of nails used, associated injury, and numbers of distal locking screws were not related to the outcome and complication (Pearson Chi-square test, P > 0.05).
Retrograde nailing may be a useful option for distal femoral fractures, but attention should be paid to comminuted fractures or fractures close to the knee joint.
评估影响逆行髓内钉治疗股骨远端骨折疗效的因素。
1999年11月至2006年6月，30例患者（共31处股骨远端骨折，其中男性15例，女性15例，1例双侧骨折）接受逆行髓内钉治疗。年龄44至82岁（平均67.2岁）。受伤原因：17例为滑倒，11例为交通事故，2例为高处坠落。受伤至手术的平均间隔时间为1.8天。根据AO/OTA分类，A1型骨折14例，A2型7例，A3型8例，C1型2例。骨折最远端线与髁间切迹的平均距离为7.2 cm（范围0至12 cm）。采用闭合逆行髓内钉固定，不扩髓，未植骨。
手术时间平均76分钟（范围45至110分钟）。所有患者均随访19至69个月，平均随访时间27个月。31处骨折中28处愈合，平均愈合时间14.7周（范围12至22周）。发生并发症7例。AO - A3型骨折中有3例骨不连，经更换内固定物或植骨治疗。2例患者远端锁定螺钉松动，予以重新固定。2例患者膝关节活动受限，屈曲小于90度。无深部感染、成角畸形超过10度或短缩超过1 cm的骨不连病例。根据Schatzker和Lambert标准，31例中有26例（84%）获得满意结果（优和良）。疗效不佳及并发症与粉碎性骨折及距髁间切迹5 cm以内的骨折有关（Pearson卡方检验，P = 0.03）。其他可能因素，包括年龄、所用髓内钉类型、合并伤及远端锁定螺钉数量，与疗效及并发症无关（Pearson卡方检验，P > 0.05）。
逆行髓内钉治疗股骨远端骨折可能是一种有效的方法，但对于粉碎性骨折或靠近膝关节的骨折应予以关注。
