两种交锁髓内钉治疗成人股骨干骨折的比较。

Comparison of two kinds of intramedullary nails in the treatment of femoral shaft fractures in adults.

机构信息

Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China.

出版信息

Chin Med J (Engl). 2011 Dec;124(23):3900-5.

Abstract

BACKGROUND

Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation exposure. Additionally, difficulties may be encountered when removing nails because of callus formation over the nail tip. We performed a prospective study to compare two types of nails in managing femoral shaft fractures.

METHODS

Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails. Group II consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires. The patients' ages, fracture severity, duration of operation, fluoroscopy time, blood loss and falls of end caps into soft tissue were recorded. Nails were removed after fracture healing. The duration of operation and blood loss during nail removal were recorded.

RESULTS

There were no significant differences between groups with respect to age and fracture severity (P > 0.05). End caps fell into soft tissue 17 times in 15 cases in group I and 21 times in 16 cases in group II. An average of seven minutes was spent recovering a lost cap in group I. In group II, all lost caps were recovered immediately. The duration of operation and fluoroscopy time in group II was significantly less than in group I (P < 0.05). Asymptomatic palpable nodules were detected in 4 cases in group II. Nail removals were performed on 58 patients in group I and 69 patients in group II. The duration of operation, blood loss and complications in group II were less than in group I (P < 0.05).

CONCLUSION

Intramedullary nails with tail wires facilitate both fracture fixation and nail removal, which can be used to treat femoral shaft fractures with less radiation exposure, shorter surgical time and fewer complications.

摘要

背景

髓内钉已广泛应用于股骨干骨折的治疗。然而，术中末端帽落入软组织可能会给术者带来麻烦，延长手术时间并增加辐射暴露。此外，由于钉尖上方的骨痂形成，在移除钉子时可能会遇到困难。我们进行了一项前瞻性研究，比较了两种类型的髓内钉治疗股骨干骨折的效果。

方法

I 组包括 74 例单侧股骨干骨折患者，采用带锁髓内钉治疗。II 组包括 78 例采用带锁髓内钉加尾丝治疗的患者。记录患者年龄、骨折严重程度、手术时间、透视时间、出血量和末端帽落入软组织的情况。骨折愈合后取出内固定。记录取出内固定时的手术时间和出血量。

结果

两组患者的年龄和骨折严重程度差异无统计学意义（P > 0.05）。I 组 15 例中有 17 次末端帽落入软组织，II 组 16 例中有 21 次。I 组平均花费 7 分钟找回丢失的帽。而在 II 组，所有丢失的帽都立即找回。II 组的手术时间和透视时间明显短于 I 组（P < 0.05）。II 组有 4 例出现无症状可触及的结节。I 组有 58 例患者和 II 组有 69 例患者进行了内固定取出术。II 组的手术时间、出血量和并发症均少于 I 组（P < 0.05）。