Perumal Ramesh, Shankar Vijay, Basha Rizwan, Jayaramaraju Dheenadayalan, Rajasekaran Shanmuganathan
Department of Orthopaedic & Spine Surgery, Ganga Hospital, Mettupalayam Road, Coimbatore 641 011, India.
J Clin Orthop Trauma. 2018 Oct-Dec;9(4):322-326. doi: 10.1016/j.jcot.2017.12.007. Epub 2017 Dec 22.
Although nail dynamization in femoral and tibial fractures is an effective method of promoting healing, its role beyond twelve weeks is still not clear. It is usually done two to three months following interlocking nailing. This study was done to evaluate the efficacy of late dynamization (after 12 weeks) and factors affecting union.
In this retrospective study, thirty seven patients who underwent dynamization for reamed intramedullary interlocking nails of femur (18) and tibia (20) after twelve weeks from index surgery and with a minimum followup of six months were included. Fracture healing index was calculated using predynamization radiographs. Radiographic union was defined as osseous bridging of three cortices on followup radiographs. Dynamization failure was defined as fractures not showing progressive increase in callus on followup radiographs and those that required secondary intervention.
Mean age of patients at time of injury was 35.92 years (range: 16-63) with males (86.8%) predominating. Mean time to dynamization from index surgery was 19.11 weeks (range-12-36). Thirty one fractures (81.5%) went onto union after dynamization of which twelve were femoral and nineteen were tibial fractures. Mean time to union after dynamization was 6 months. Communited fractures (6-21) showed poor results with delayed dynamization compared to other anatomical types which was statistically significant (P = 0.05). Predynamization FHI of more than 1.18 had 83% sensitivity and 72% specificity in predicting fracture healing after dynamization.
Late dynamization is still beneficial in promoting healing in femoral and tibial fractures. Communited fractures showed poor results with dynamization. Predynamization FHI was an important predictor of fracture healing.
尽管股骨和胫骨骨折的髓内钉动力化是促进骨折愈合的有效方法，但其在12周后的作用仍不明确。动力化通常在交锁髓内钉固定后两到三个月进行。本研究旨在评估晚期动力化（12周后）的疗效以及影响骨折愈合的因素。
本回顾性研究纳入了37例患者，这些患者在初次手术后12周对股骨（18例）和胫骨（20例）的扩髓交锁髓内钉进行了动力化处理，且随访时间至少为6个月。使用动力化前的X线片计算骨折愈合指数。影像学愈合定义为随访X线片上出现三个皮质骨的骨桥连接。动力化失败定义为随访X线片上骨痂未呈现逐渐增加以及需要二次干预的骨折。
患者受伤时的平均年龄为35.92岁（范围：16 - 63岁），男性占主导（86.8%）。从初次手术到动力化的平均时间为19.11周（范围 - 12 - 36周）。动力化后31例骨折（81.5%）实现愈合，其中股骨骨折12例，胫骨骨折19例。动力化后至愈合的平均时间为6个月。与其他解剖类型相比，粉碎性骨折（6 - 21例）动力化延迟后的结果较差，差异具有统计学意义（P = 0.05）。动力化前骨折愈合指数大于1.18在预测动力化后骨折愈合方面具有83%的敏感性和72%的特异性。
晚期动力化对促进股骨和胫骨骨折愈合仍有益处。粉碎性骨折动力化后的结果较差。动力化前骨折愈合指数是骨折愈合的重要预测指标。
