Sipahioglu S, Zehir S, Sarikaya B, Isikan U E
Department of Orthopedics and Traumatology, Harran University Medical Faculty, Sanliurfa, Turkey.
Department of Orthopedics and Traumatology, Hitit University, Corum, Turkey.
Niger J Clin Pract. 2017 Jul;20(7):792-798. doi: 10.4103/1119-3077.212452.
Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur.
Isolated closed AO = Arbeitsgemeinschaft für Osteosynthesefragen type 32.A or 32.B unilateral femoral shaft fractures operated with expandable or locked nail were evaluated retrospectively. We match patients who undergone expandable nail fixation with patients of the same-sex, age, and fracture type who undergone locked nailing. A match was done for 31 expandable nail. At follow up, healing was assessed radiologically and clinically. Outcome measures included duration of hospital stay, time taken to achieve bony union, and participation in full activities.
The average duration of surgery in the expandable group was 60.9 min and in the locked group was 82.4 min. In the expandable group, the average clinical healing time was 15.5 weeks and radiographic healing time was 21.7 weeks. In the locked IMN group, the average clinical healing time was 18.4 weeks and the average radiographic healing time was 24.1 weeks. We observed seven (22.6%) non-union in expandable group and four (12.9%) non-union in locked group. In the expandable group, type of the fracture was AO 32.B in all of the non-union patients. We achieved union in all of non-unions of the locked group only with dynamization. In the expandable IMN group, five (16.1%) patients required major surgery, in the locked group none of the patients required major surgery.
Non-union rate of the expandable nail is higher than that of the locked nail for femoral diaphyseal fractures. It may be a treatment option in simple fractures like AO 32.A and in patients where rapid fixation is demanded. It has advantages of reduced operative time and less radiation exposure in comparison with reported series of conventional nails.
可膨胀髓内钉仅通过液压膨胀实现稳定性；因此，其辐射暴露和手术时间较少。在本研究中，我们旨在比较可膨胀股骨钉与带锁髓内钉治疗股骨干骨折的效果。
回顾性评估采用可膨胀或带锁髓内钉治疗的孤立闭合性AO（AO = Arbeitsgemeinschaft für Osteosynthesefragen）32.A型或32.B型单侧股骨干骨折。我们将接受可膨胀髓内钉固定的患者与接受带锁髓内钉固定的同性、年龄和骨折类型相同的患者进行匹配。为31枚可膨胀髓内钉进行了匹配。随访时，通过影像学和临床评估骨折愈合情况。观察指标包括住院时间、达到骨愈合所需时间以及参与全部活动的情况。
可膨胀组的平均手术时间为60.9分钟，带锁组为82.4分钟。在可膨胀组，平均临床愈合时间为15.5周，影像学愈合时间为21.7周。在带锁髓内钉组，平均临床愈合时间为18.4周，平均影像学愈合时间为24.1周。我们观察到可膨胀组有7例（22.6%）骨不连，带锁组有4例（12.9%）骨不连。在可膨胀组，所有骨不连患者的骨折类型均为AO 32.B型。带锁组的所有骨不连患者仅通过动力化实现了骨折愈合。在可膨胀髓内钉组，5例（16.1%）患者需要进行二次手术，带锁组无患者需要二次手术。
对于股骨干骨折，可膨胀髓内钉的骨不连发生率高于带锁髓内钉。它可能是AO 32.A型等简单骨折以及需要快速固定的患者的一种治疗选择。与报道的传统髓内钉系列相比，它具有手术时间缩短和辐射暴露减少的优点。
