Detroit Receiving Hospital, 4201 St Antoine Street, Detroit, MI, 48201, USA,
Clin Orthop Relat Res. 2013 Dec;471(12):3974-80. doi: 10.1007/s11999-013-3058-8.
The use of retrograde nailing for gunshot wound femur fractures is controversial due to concerns of knee sepsis after this procedure since the knee is entered to introduce the nail into the canal.
QUESTIONS/PURPOSES: We compared retrograde and antegrade nailing for gunshot femur fractures to determine whether (1) knee sepsis or other adverse events were more likely to complicate procedures using retrograde nails, (2) there were differences in surgical time or blood loss, and (3) there were differences in radiographic union.
We retrospectively reviewed our prospective trauma database from 1999 to 2012 for patients with a diagnosis of gunshot and femur fracture. We performed a detailed review of medical records and radiographs for those patients with OTA Classification Type 32 femur fractures secondary to gunshot injury treated with either retrograde or antegrade femoral nailing. Eighty-one patients were treated with intramedullary nailing (53 retrograde and 28 antegrade). We reviewed elements of the operative treatment (procedure, anesthesia time, operative time, and estimated blood loss) for all 81 patients. For clinical and radiographic review, followup was adequate for 43 and 25 patients with retrograde and antegrade nailing, respectively. Minimum followup was 3 months for both groups (retrograde: mean, 41 months; range, 3-148 months; antegrade: 26 months: range, 3-112 months).
No patients in either group developed knee sepsis. No significant differences were found between groups with regard to operative time, blood loss, or radiographic union.
With the numbers available, immediate retrograde nailing appears as safe and effective as antegrade nailing for gunshot femur fractures. Immediate retrograde nailing is as safe as antegrade nailing for gunshot femur fractures.
由于担心逆行钉入会导致膝关节感染，因此对于使用逆行钉治疗枪弹伤股骨骨折存在争议，因为需要进入膝关节将钉引入管内。
问题/目的：我们比较了逆行和顺行钉治疗枪弹伤股骨骨折，以确定（1）逆行钉治疗是否更有可能导致膝关节感染或其他不良事件，（2）手术时间或失血量是否存在差异，以及（3）影像学愈合是否存在差异。
我们回顾性分析了 1999 年至 2012 年我们前瞻性创伤数据库中因枪击伤导致股骨骨折的患者。我们对 OTA 分类 32 型股骨骨折的患者进行了详细的病历和影像学检查，这些患者因枪击伤接受了逆行或顺行股骨钉治疗。81 例患者接受了髓内钉治疗（53 例逆行钉，28 例顺行钉）。我们对 81 例患者的手术治疗（手术类型、麻醉时间、手术时间和估计失血量）进行了评估。对于临床和影像学评估，分别有 43 例和 25 例接受逆行和顺行钉治疗的患者随访时间足够，随访时间最短为 3 个月（逆行组：平均 41 个月，范围 3-148 个月；顺行组：26 个月，范围 3-112 个月）。
两组均无患者发生膝关节感染。两组在手术时间、失血量或影像学愈合方面无显著差异。
根据目前的病例数，立即进行逆行钉固定似乎与顺行钉固定一样安全有效，可用于治疗枪弹伤股骨骨折。立即进行逆行钉固定与顺行钉固定治疗枪弹伤股骨骨折一样安全。
