Department of Traumatology, University Medical Center Groningen, Groningen, The Netherlands.
Injury. 2012 Jul;43(7):1154-8. doi: 10.1016/j.injury.2012.03.011. Epub 2012 Apr 6.
The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the long-term functional outcome after antegrade or retrograde intramedullary nailing of traumatic femoral shaft fractures. We further determined predictors of these functional outcome scores.
In a retrospective study, patients with a femoral shaft fracture but no other injuries to the lower limbs or pelvis were included. A total of 59 patients met the inclusion criteria. Functional outcome scores (Short Musculoskeletal Functional Assessment (SMFA), Western Ontario and McMaster University Osteoarthritis (WOMAC) index, Harris Hip Score (HHS) and the Lysholm knee function scoring scale) were measured at a mean of 7.8 years (± 3.5 years) postoperatively. The Visual Analogue Scale (VAS) was used to determine pain complaints of the lower limb.
The range of motion (ROM) of the hip and knee joints was comparable between the injured and uninjured leg, regardless of the nailing technique. Correlation between ROM and the final outcome scores was found to be fair to moderate. Even years after surgery, 17% of the patients still reported moderate to severe pain. A substantial correlation was observed between VAS and the patient-reported outcome scores. The most significant predictor of functional outcome was pain in the lower limb.
Our findings suggest that the ROM of hip and knee returns to normal over time, regardless of the nailing method used. However, pain in the lower limb is an important predictor and source of disability after femoral shaft fractures, even though most patients achieved good functional outcome scores.
髓内钉治疗股骨干骨折是一种常用的方法。本研究旨在评估顺行或逆行髓内钉治疗创伤性股骨干骨折的长期功能结果。我们进一步确定了这些功能结果评分的预测因素。
在一项回顾性研究中，纳入了无下肢或骨盆其他损伤的股骨干骨折患者。共有 59 名患者符合纳入标准。术后平均 7.8 年（±3.5 年）时，采用短肢体肌肉骨骼功能评估（SMFA）、安大略西部和麦克马斯特大学骨关节炎（WOMAC）指数、髋关节Harris 评分（HHS）和膝关节 Lysholm 功能评分量表测量功能结果评分。采用视觉模拟评分（VAS）评估下肢疼痛症状。
髋关节和膝关节的活动度（ROM）在患侧和健侧之间无明显差异，与钉入技术无关。ROM 与最终结果评分之间存在中度到高度的相关性。即使在手术后多年，仍有 17%的患者报告有中度到重度疼痛。VAS 与患者报告的结果评分之间存在显著相关性。功能结果的最重要预测因素是下肢疼痛。
我们的研究结果表明，髋关节和膝关节的 ROM 会随着时间的推移而恢复正常，无论使用何种钉入方法。然而，下肢疼痛是股骨干骨折后残疾的重要预测因素和来源，尽管大多数患者的功能结果评分良好。
