Lee J R, Kim H-J, Lee K-B
Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea.
Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea.
Orthop Traumatol Surg Res. 2016 Apr;102(2):175-81. doi: 10.1016/j.otsr.2015.11.014. Epub 2016 Jan 27.
The femoral shaft fractures with large fragments makes anatomical reduction challenging and often results in non-union. In some studies, the degree of fragment displacement was reported to have affected non-union, but the association between the one fragment size and degree of displacement has not been fully clarified. Therefore we performed a retrospective study to assess: (1) the more influential factor of non-union: the degree of fragment displacement, or the fragment size? (2) the non-union rates according to different sizes and degrees of displacement.
The degree of displacement is the more potent factor of non-union than the third fragment size in femoral shaft fractures.
We assessed retrospectively 64 cases, which could be followed up for longer than one year. Fragments were divided according to the length of their long axis into three groups: group A (0-3.9cm), (n=21); group B (4-7.9cm), (n=22); group C (8cm or more), (n=21). Fragment displacement was also assessed in the proximal (P) or distal (D) end to the nearest cortex of the femoral shaft, and divided into the following groups: group P1 (n=44) or D1 (n=47), (0-9mm); group P2 (n=10) or D2 (n=11), (10-19mm); group P3 (n=7) or D3 (n=3), (20-29mm); and group P4 (n=3) or D4 (n=3), (30mm or more).
The bone union rate was 86% in the small (less than 8cm) fragment groups and 71% in the large (8cm or more) fragment group (P=0.046). With respect to the degree of displacement, the union rate was lower (P=0.001) and the average union time was longer (P=0.012) in the 20mm or more group for both the proximal fragment part and the distal fragment part (P=0.002, P=0.014). A logistic regression analysis underlined the displacement in the proximal site (OR: 0.298, 95% CI: 0.118-0.750) as in the distal site (OR: 0.359, 95% CI: 0.162-0.793) as a larger effect on union rate than the fragment size that as no effect in logistic regression (OR 3.8, 95% CI: 0.669-21.6).
Non-union develops significantly more frequently in femoral shaft fractures with fragments 8cm or longer or when the displacement in the proximal area is 20mm or greater and 10mm or greater in the distal area during the intramedullary nailing procedure. Regarding union rate, the degree of displacement has more influence than the third fragment size in femoral shaft fractures.
IV, retrospective cohort study.
伴有大骨折块的股骨干骨折实现解剖复位具有挑战性，且常导致骨不连。在一些研究中，有报道称骨折块移位程度会影响骨不连，但骨折块大小与移位程度之间的关联尚未完全阐明。因此，我们进行了一项回顾性研究，以评估：（1）对骨不连影响更大的因素：骨折块移位程度还是骨折块大小？（2）根据不同大小和移位程度的骨不连发生率。
在股骨干骨折中，移位程度比骨折块大小对骨不连的影响更大。
我们回顾性评估了64例可随访超过1年的病例。根据骨折块长轴长度将其分为三组：A组（0 - 3.9cm），（n = 21）；B组（4 - 7.9cm），（n = 22）；C组（8cm及以上），（n = 21）。还评估了骨折块在股骨干最靠近皮质的近端（P）或远端（D）的移位情况，并分为以下几组：P1组（n = 44）或D1组（n = 47），（0 - 9mm）；P2组（n = 10）或D2组（n = 11），（10 - 19mm）；P3组（n = 7）或D3组（n = 3），（20 - 29mm）；以及P4组（n = 3）或D4组（n = 3），（30mm及以上）。
小（小于8cm）骨折块组的骨愈合率为86%，大（8cm及以上）骨折块组为71%（P = 0.046）。就移位程度而言，近端骨折块部分和远端骨折块部分在移位20mm及以上组的愈合率较低（P = 0.001），平均愈合时间较长（P = 0.012）（近端P = 0.002，远端P = 0.014）。逻辑回归分析强调，近端部位的移位（OR：0.298，95%CI：0.118 - 0.750）与远端部位的移位（OR：0.359，95%CI：0.162 - 0.793）对愈合率的影响大于骨折块大小，而骨折块大小在逻辑回归中无影响（OR 3.8，95%CI：0.669 - 21.6）。
在髓内钉固定过程中，当骨折块长度为8cm或更长，或近端移位20mm或更大且远端移位10mm或更大时，股骨干骨折发生骨不连的频率显著更高。关于愈合率，在股骨干骨折中，移位程度比骨折块大小的影响更大。
IV，回顾性队列研究。
