在卫生条件较差的情况下使用髓内钉：法国军队医疗服务的经验。

Use of intramedullary nailing in poor sanitary conditions: French Military Medical Service experience.

机构信息

Service de chirurgie orthopédique et traumatologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.

出版信息

Orthop Traumatol Surg Res. 2019 Feb;105(1):173-177. doi: 10.1016/j.otsr.2018.10.017. Epub 2019 Jan 10.

DOI:10.1016/j.otsr.2018.10.017

PMID:30639030

Abstract

INTRODUCTION

Intramedullary (IM) nailing is the gold standard for treating long bone fractures in developed countries because of its minimally-invasive application and good biomechanical properties. In precarious conditions, external fixation or open plate fixation are often performed because surgeons do not have the means to carry out IM nailing. However, these procedures can lead to infection-related complications and mechanical failures. The aim of our study was to describe the outcomes and postoperative complications of IM nailing of closed, long bone fractures in patients operated in a French front-line combat surgical unit (role 2+). Our hypothesis was that IM nailing is a reliable technique with low morbidity for the initial treatment of long bone fractures, even in precarious situations.

MATERIAL AND METHODS

This was a prospective, single-center, descriptive study of patients operated on between April 2016 and November 2017. All the patients with a closed femur or tibia fracture who were treated by IM nailing were eligible, no matter their time to surgery. The minimum follow-up was 6 months. The primary endpoint was the absence of infection-related complications and the secondary endpoint was fracture union.

RESULTS

Fifty-eight patients were reviewed after an average follow-up of 4.7 months (range, 3-15 months). The mean patient age was 35.2 years (15-85 years) and the majority of patients were men (52 of 58). The fracture was in the femur in 74.1% (n=43) of cases and in the tibia in 25.9% (n=15) of cases. The time to surgery averaged 122.3 days (7-720 days) with a median of 60 days. In 74% of cases (n=43), fracture realignment required an open surgical approach. The postoperative course was considered normal in 96.6% of cases (n=51). No infections were reported as of the last follow-up visit. Union occurred in an average of 4 months in 70.7% of cases (n=41). There were three cases of nonunion after 6 months.

DISCUSSION

Even in precarious situations, IM nailing is an effective, reliable method with a low complication risk and high union rate for the treatment of neglected long bone fractures. This surgical treatment is well suited to the poor sanitary conditions on the African continent.

LEVEL OF EVIDENCE

II, low-powered prospective study.

摘要

引言

在发达国家，髓内钉（IM）固定是治疗长骨骨折的金标准，因为它具有微创应用和良好的生物力学特性。在不稳定的情况下，由于外科医生没有手段进行髓内钉固定，通常会进行外固定或开放式钢板固定。然而，这些手术可能会导致与感染相关的并发症和机械故障。我们的研究目的是描述在法国一线作战外科部队（角色 2+）进行手术的患者中闭合性长骨骨折的髓内钉治疗的结果和术后并发症。我们的假设是，即使在不稳定的情况下，髓内钉固定术也是一种可靠的技术，具有较低的发病率，可用于初始治疗长骨骨折。

材料和方法

这是一项前瞻性、单中心、描述性研究，纳入 2016 年 4 月至 2017 年 11 月期间接受手术治疗的患者。所有接受髓内钉治疗的闭合性股骨或胫骨骨折患者均符合条件，无论手术时间如何。最低随访时间为 6 个月。主要终点是无感染相关并发症，次要终点是骨折愈合。

结果

平均随访 4.7 个月（3-15 个月）后，对 58 例患者进行了回顾性分析。患者平均年龄为 35.2 岁（15-85 岁），大多数为男性（52/58）。骨折位于股骨 74.1%（n=43），胫骨 25.9%（n=15）。手术时间平均为 122.3 天（7-720 天），中位数为 60 天。74%（n=43）的病例需要切开复位。96.6%（n=51）的病例术后过程正常。截至最后一次随访，无感染报告。平均 70.7%（n=41）的病例在 4 个月时愈合。6 个月后有 3 例出现骨折不愈合。