Omerovic Djemil, Lazovic Faruk, Hadzimehmedagic Amel
Department of Orthopedics and Traumatology, Clinical Center University of Sarajevo, Bosnia and Herzegovina.
Department of Cardiovascular surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina.
Med Arch. 2015 Apr;69(2):110-3. doi: 10.5455/medarh.2015.69.110-113. Epub 2015 Apr 6.
The basic principle of non-surgical fracture treatment is to restore the original anatomical position of fractured fragments by different techniques, without direct access to the bone and without further traumatizing of tissues. Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goal to gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment.
The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results.
The study was conducted at the Clinic for Orthopaedics and Traumatology, Clinical Center University Sarajevo from January 2004 to June 2009. The study was retrospective-prospective, manipulative, controlled and it was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B, with different segments of bone, regardless of sex and age structure, with the exception of children under 14 years of age.
Precisely there were 47 patients with femoral fractures and 82 patients with tibial fractures. The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382). The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978). We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus.
Static intramedullary osteosynthesis resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.
非手术骨折治疗的基本原则是通过不同技术恢复骨折碎片的原始解剖位置，无需直接接触骨骼且不进一步损伤组织。髓内钉固定是骨折碎片的合成与巩固，主要目标是增强植入物的强度并使其永久固定。髓内骨固定术采用两种技术：使用动力型或静力型髓内钉。动力化包括通过从最长碎片上移除螺钉将静力型髓内钉转换为动力型。
本研究的目的是确定使用静力型或动力型髓内钉治疗的股骨和胫骨A、B型骨折在愈合速度和质量上是否存在差异，并比较结果。
本研究于2004年1月至2009年6月在萨拉热窝大学临床中心骨科与创伤科诊所进行。该研究为回顾性-前瞻性、操作性、对照性研究，共纳入129例股骨和胫骨骨干A、B型闭合性骨折患者，骨折部位不同，不考虑性别和年龄结构，但14岁以下儿童除外。
确切地说，有47例股骨骨折患者和82例胫骨骨折患者。股骨和胫骨骨折的平均愈合周数略有利于静力型髓内骨固定术，为17.08周（标准差=3.382）。23例采用动力型髓内骨固定术治疗的股骨骨折患者的平均愈合周数为17.83周（标准差=2.978）。我们可以得出结论，静力型髓内钉固定术可防止骨折碎片之间的移动，这直接刺激骨形成并形成最小量的骨痂。
静力型髓内骨固定术解决了骨折稳定、肢体缩短和碎片旋转的问题。
