Attal R, Blauth M
Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, A-6020 Innsbruck, Osterreich.
Orthopade. 2010 Feb;39(2):182-91. doi: 10.1007/s00132-009-1524-5.
Reaming and non-reaming of intramedullary nails in long bone fractures was a controversial and even emotional topic in recent decades. This article gives an historical overview of the development in this field and presents the background to the need for unreamed nailing. Furthermore, the current state of knowledge is illustrated by describing the results of a series of randomised controlled trials. Before the year 2000 nearly all German handbooks on orthopaedic and trauma surgery recommended unreamed intramedullary nailing as a more "biological" treatment that causes less harm to vascularity with equal or even better results. Unreamed nailing was in particular advocated for the treatment of open fractures. The tide turned as randomised controlled trials conducted since 2000 gave evidence that unreamed nailing leads to a higher rate of delayed or non-union, while the advantages to blood supply and infection rate could not be proven. According to evidence based medicine isolated femur and tibia fractures should be nailed in a reamed procedure. In a severe multiple injury setting it is safer to stabilize long bone fractures with external fixators, as adverse events are described for reamed and unreamed nailing.
近几十年来，长骨骨折中髓内钉的扩髓与非扩髓一直是一个有争议甚至情绪化的话题。本文对该领域的发展进行了历史回顾，并阐述了非扩髓髓内钉固定需求的背景。此外，通过描述一系列随机对照试验的结果来说明当前的知识状态。2000年以前，几乎所有德国骨科与创伤外科学手册都推荐非扩髓髓内钉固定，认为这是一种更“生物学”的治疗方法，对血运的损害较小，且疗效相同甚至更好。非扩髓髓内钉固定尤其适用于开放性骨折的治疗。自2000年以来进行的随机对照试验表明，非扩髓髓内钉固定导致延迟愈合或骨不连的发生率更高，而其对血供和感染率的优势并未得到证实，形势因此发生了转变。根据循证医学，孤立的股骨和胫骨骨折应采用扩髓方法进行髓内钉固定。在严重多发伤的情况下，使用外固定器固定长骨骨折更为安全，因为扩髓和非扩髓髓内钉固定均有不良事件的报道。
