Department of Orthopedic Trauma, Harris Methodist Hospital-Fort Worth, TX, USA.
J Orthop Trauma. 2010 Dec;24(12):717-22. doi: 10.1097/BOT.0b013e3181f6bfe8.
In 2004, we modified our technique for the stabilization of femoral shaft fractures so that all fractures were stabilized using a reconstruction nail with proximal locking screws oriented into the femoral head. The rationale for this was twofold: first, potentially "missed" associated femoral neck fractures would be stabilized. Second, hip fractures that might occur later in life above the intramedullary nail might be avoided. The purpose of this study therefore was to determine whether there were any risks to patients treated for femoral shaft fractures with antegrade nails using cephalomedullary proximal locking screws.
Retrospective.
Two regional trauma centers.
PATIENTS/PARTICIPANTS: Eighty-seven consecutive patients were treated for a femoral shaft fracture treated with antegrade femoral nailing with a cephalomedullary locked nail.
Reamed, trochanteric insertion of an intramedullary nail with proximal locking screws placed in a cephalomedullary direction.
Patient and injury data, radiographic analyses, and complications of treatment were assessed at a minimum of 12 months.
Sixty-one of 87 patients (70%) were available at a mean of 19.8 months (range, 12-44 months). Sixty of 61 fractures united after the index procedure. Complications included one delayed union successfully treated with exchange nailing, one distal locking screw fracture (allowing dynamization and completion of fracture healing), two patients with postoperative deformity that required a derotation procedure, and two drill bits that broke intraoperatively and were retained. There were no major complications at the hip, no migration or failure of proximal locking screws, and no screws required removal.
Using a reconstruction nail and cephalomedullary proximal locking screws for antegrade femoral nailing of femoral shaft fractures was not associated with major complications in this series. This modification of standard femoral nailing offers potential advantages, including fixation of any "missed" associated femoral neck fractures and prevention of late hip fractures that might occur above the nail.
2004 年，我们修改了股骨干骨折的稳定技术，使所有骨折均使用带近端锁定螺钉的重建钉固定于股骨头内。这样做有两个原因：首先，可能“漏诊”的相关股骨颈骨折将得到固定。其次，可能避免发生在髓内钉上方的后期生活中的髋部骨折。因此，本研究的目的是确定使用顺行髓内钉和股骨近端交锁钉治疗股骨干骨折的患者是否存在任何风险。
回顾性研究。
两个区域性创伤中心。
患者/参与者：87 例连续患者因股骨干骨折接受顺行股骨钉内固定治疗，采用带交锁近端钉的顺行股骨钉。
扩髓，经转子插入髓内钉，用交锁钉沿股骨近端方向放置。
至少 12 个月时评估患者和损伤数据、影像学分析和治疗并发症。
87 例患者中有 61 例（70%）可获得，平均随访 19.8 个月（范围 12-44 个月）。60 例骨折在初次手术后愈合。并发症包括 1 例延迟愈合，经交锁钉更换成功治疗；1 例远端锁定螺钉骨折（允许动力化和骨折愈合完成）；2 例术后畸形患者需要行旋转移位术；2 例术中断钉并保留。髋关节无重大并发症，无近端锁定螺钉迁移或失效，无需取出螺钉。
在本系列中，使用重建钉和股骨近端交锁螺钉进行股骨干骨折顺行髓内钉固定与重大并发症无关。这种标准股骨钉固定的改良方法具有潜在优势，包括固定任何“漏诊”的相关股骨颈骨折和防止可能发生在钉上方的后期髋部骨折。
