Niikura Takahiro, Lee Sang Yang, Matsumoto Tomoyuki, Fukui Tomoaki, Kawakami Yohei, Akisue Toshihiro, Kuroda Ryosuke, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Orthopedics. 2012 Aug 1;35(8):e1264-6. doi: 10.3928/01477447-20120725-31.
This article describes a case of backout of the helical blade, a rare complication of proximal femoral nail antirotation. A 31-year-old man had sustained a trochanteric fracture of his right femur. Fracture fixation using proximal femoral nail antirotation and autologous bone grafting 7 months later were performed at another hospital. However, bony union was not obtained, and the patient's pain and limp persisted. Therefore, he presented to the current authors. A radiograph taken at presentation revealed backout of the helical blade and fracture nonunion. A radiograph taken 1 month later showed a more advanced backout of the helical blade. The authors performed exchange nailing supplemented with transplantation of peripheral blood CD34-positive cells and autologous bone grafting. The proximal femoral nail antirotation was revised to a long gamma 3 nail, and a U-lag screw was used to obtain better stability. The postoperative course was uneventful. The patient regained ambulation without pain or support at 12 weeks postoperatively. Radiographic bony union was completed 9 months postoperatively. At 1-year follow-up, he could run and stand on the previously injured leg and had returned to work. Backout of the helical blade should be considered as a possible complication of proximal femoral nail antirotation. Incomplete fixation of the helical blade is the possible reason for backout. The use of a helical blade in young patients may cause difficulty in insertion and result in incomplete fixation.
本文描述了1例螺旋刀片退出的病例，这是股骨近端抗旋髓内钉罕见的并发症。一名31岁男性右股骨转子间骨折。7个月后在另一家医院采用股骨近端抗旋髓内钉及自体骨移植进行骨折固定。然而，骨折未愈合，患者疼痛和跛行持续存在。因此，他前来就诊于本文作者。就诊时拍摄的X线片显示螺旋刀片退出及骨折不愈合。1个月后拍摄的X线片显示螺旋刀片退出更严重。作者进行了更换髓内钉，并辅以外周血CD34阳性细胞移植及自体骨移植。将股骨近端抗旋髓内钉翻修为加长型伽马3髓内钉，并使用U型拉力螺钉以获得更好的稳定性。术后过程顺利。患者术后12周可无痛且无需支撑行走。术后9个月X线片显示骨折完全愈合。在1年随访时，他能够用先前受伤的腿跑步和站立，并已重返工作岗位。螺旋刀片退出应被视为股骨近端抗旋髓内钉可能的并发症。螺旋刀片固定不完整可能是退出的原因。在年轻患者中使用螺旋刀片可能导致插入困难并导致固定不完整。
