Herscovici Dolfi, Scaduto Julia M
Florida Orthopaedic Institute, 13020 Telecom Parkway, Temple Terrace, FL, 33637, USA,
Clin Orthop Relat Res. 2014 Sep;472(9):2745-50. doi: 10.1007/s11999-013-3292-0.
Nailing comminuted femur fractures may result in leg shortening, producing significant complications including pelvic tilt, narrowing of the hip joint space, mechanical and functional changes in gait, an increase in energy expenditures, and strains on spinal ligaments, leading to spinal deformities. The frequency of this complication in patients managed with an intramedullary (IM) nail for comminuted diaphyseal fractures is unknown.
QUESTIONS/PURPOSES: We therefore determined (1) the frequency of LLDs, (2) whether a specific fracture pattern was associated with LLDs, (3) the frequency of reoperation, and (4) whether revision fixation ultimately corrected the LLD.
We studied 83 patients with 91 AO/OTA Type B or Type C fractures fixed with either an antegrade or retrograde IM nail from July 2002 through December 2005. There were 60 males and 23 females, with a mean age of 30 years (range, 15-79 years). All underwent a digitized CT scan in the immediate postoperative period. Measurements of both legs were performed. Any fixation producing a discrepancy and requiring a return to surgery was identified.
An mean LLD of 0.58 cm was found in 98% of the patients, but only six (7%) patients had an LLD of greater than 1.25 cm. No fracture pattern or the presentation of bilateral injuries demonstrated a greater incidence of LLD. Of the patients with LLD, two patients refused further surgery while the remaining four patients, two Type B and two Type C fractures, ultimately underwent revision fixation. Repeat CT scans after revision surgery of all four patients demonstrated a residual LLD of only 0.2 cm.
Postoperative CT scans appear to be an efficient method to measure femoral length after IM nailing. Although residual LLDs may be common in comminuted femurs treated with IM nails, most LLDs do not appear to be functionally relevant. When an LLD of greater than 1.5 cm is identified, it should be discussed with the patient, who should be told that potential complications may occur with larger LLDs and that sometimes patients may benefit from repeat surgery.
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
髓内钉固定股骨干粉碎性骨折可能导致肢体短缩，引发包括骨盆倾斜、髋关节间隙变窄、步态力学和功能改变、能量消耗增加以及脊柱韧带劳损等严重并发症，进而导致脊柱畸形。采用髓内钉治疗股骨干粉碎性骨折患者中该并发症的发生率尚不清楚。
问题/目的：因此，我们确定了（1）肢体短缩（LLD）的发生率，（2）特定骨折类型是否与肢体短缩相关，（3）再次手术的发生率，以及（4）翻修固定最终是否纠正了肢体短缩。
我们研究了2002年7月至2005年12月期间采用顺行或逆行髓内钉固定91例AO/OTA B型或C型骨折的83例患者。其中男性60例，女性23例，平均年龄30岁（范围15 - 79岁）。所有患者术后即刻均接受数字化CT扫描。测量双下肢。确定任何导致差异且需要再次手术的固定情况。
98%的患者平均肢体短缩0.58 cm，但只有6例（7%）患者肢体短缩超过1.25 cm。没有骨折类型或双侧损伤表现显示肢体短缩发生率更高。在肢体短缩的患者中，2例患者拒绝进一步手术，其余4例患者，2例B型骨折和2例C型骨折，最终接受了翻修固定。4例患者翻修手术后重复CT扫描显示残余肢体短缩仅0.2 cm。
术后CT扫描似乎是髓内钉固定后测量股骨长度的有效方法。虽然在采用髓内钉治疗的粉碎性股骨中残余肢体短缩可能很常见，但大多数肢体短缩似乎在功能上无关紧要。当确定肢体短缩大于1.5 cm时，应与患者讨论，告知患者较大的肢体短缩可能会出现潜在并发症，有时患者可能从再次手术中获益。
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
