Trauma Department, Hannover Medical School, Hannover, Germany.
J Orthop Trauma. 2011 Apr;25(4):224-7. doi: 10.1097/BOT.0b013e3181e47e3b.
The objective of this study was to determine which clinical factors influence the presence and extent of femoral malrotation during unreamed nail insertion performed without a fracture table.
Retrospective chart review.
Academic trauma center.
Patients were treated statically locked femoral nails inserted without reaming in either a retrograde or antegrade manner without the use of a fracture table between April 1, 2000, and December 31, 2005. All patients received postoperative computed tomography scans. Institutional radiographic threshold for revision surgery was 15° of either internal or external rotation.
Postoperative computed tomography measurements of rotation were compared with the opposite side. Patients were grouped by 1) Orthopaedic Trauma Association fracture classification; 2) closed versus mini open reduction; 3) surgeon experience; 4) antegrade versus retrograde femoral nail; and 5) time of day surgery performed (day shift versus night shift). The following parameters were measured from the chart and x-ray: rotational malalignment, x-ray time, and duration of surgery.
There were 82 femurs in 82 patients, 59 men and 23 women, with a mean age of 32 years (range, 17-83 years). Eighteen femurs (22%) showed a malrotation of greater than 15°. Seven were internally malrotated (mean, 23°; range 16°-32°), whereas 11 were externally malrotated (mean, 24.2°; range, 16°-39.7°). After clinical examination, only 11 of the 18 patients (61%) underwent revision surgery, six patients for external malrotation (mean, 27.47°; range, 21.9°-39.7°) and five for internal malrotation (mean, 23.6°; range, 16°-32°). Malrotation varied significantly with fracture severity with Type C averaging 19.4° (24 patients), Type B 9° (26 patients), and Type A 6.6° (32 patients). No difference was found between an open and closed technique nor the experience of surgeon or the type of implant. There was a significant difference depending on the time of surgery in which an average malrotation of 15.2° (14 patients) was found on the night shift and an average malrotation of 10.3° (68 patients) was found during the day.
Rotational malalignment greater than 15° was found in 22% of femurs treated in this study. Fracture comminution and time of day the surgery was performed had the greatest effect on the severity of malrotation.
本研究旨在确定在不使用骨折复位台的情况下，进行非扩髓髓内钉插入术时，哪些临床因素会影响股骨旋转的存在和程度。
回顾性图表分析。
学术创伤中心。
2000 年 4 月 1 日至 2005 年 12 月 31 日期间，采用静态锁定股骨钉逆行或顺行插入，不使用骨折复位台，治疗无移位的股骨骨折。所有患者术后均行计算机断层扫描检查。机构影像学翻修手术的阈值为 15°内旋或外旋。
术后 CT 测量旋转与对侧比较。患者根据 1）骨科创伤协会骨折分类；2）闭合与小切口复位；3）手术医生经验；4）顺行与逆行股骨钉；5）手术时间（白班与夜班）进行分组。从图表和 X 线片中测量以下参数：旋转对线不良、X 线时间和手术时间。
82 例患者 82 侧股骨，59 例男性，23 例女性，平均年龄 32 岁（17-83 岁）。18 例（22%）股骨存在大于 15°的旋转不良。其中 7 例为内旋（平均 23°；范围 16°-32°），11 例为外旋（平均 24.2°；范围 16°-39.7°）。临床检查后，仅 18 例患者中的 11 例（61%）接受了翻修手术，其中 6 例为外旋（平均 27.47°；范围 21.9°-39.7°），5 例为内旋（平均 23.6°；范围 16°-32°）。旋转不良与骨折严重程度显著相关，C 型平均 19.4°（24 例），B 型 9°（26 例），A 型 6.6°（32 例）。开放和闭合技术、手术医生的经验或植入物类型之间无差异。手术时间有显著差异，夜班时平均旋转 15.2°（14 例），白班时平均旋转 10.3°（68 例）。
本研究中，22%的股骨存在大于 15°的旋转对线不良。骨折粉碎程度和手术时间对旋转不良的严重程度影响最大。
