Hamahashi Kosuke, Uchiyama Yoshiyasu, Kobayashi Yuka, Ebihara Goro, Ukai Taku, Watanabe Masahiko
Department of Orthopaedic Surgery, SurgicalScience, Tokai University School of Medicine, Isehara, Japan.
Trauma Surg Acute Care Open. 2019 Mar 27;4(1):e000203. doi: 10.1136/tsaco-2018-000203. eCollection 2019.
This study retrospectively evaluated the clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments and analyzed the risk factors for delayed union.
Retrospective analyses involving 51 patients who underwent intramedullary nailing of femoral shaft fractures with third fragments (AO classification type B, 35 cases; type C, 16 cases) were conducted. Delayed union was defined as either more than 10 months required for callus formation in more than three of the four cortical bone surfaces observed in the frontal and lateral radiographic views or the requirement for additional surgery such as nail conversion or bone transplantation. Seventeen patients developed delayed union (D group). Thirty-four patients achieved bony union within 9 months (U group). The following background variables were compared between groups: age at the time of the injury; AO classification; ratio of open fracture; waiting period before surgery; rate of the infraisthmal fracture; diameter of the intramedullary nail; ratio of the intramedullary nail to the femur; length and displacement of the third fragment; and use of open reduction, poller screws, or dynamization.
Significant differences were found between the D and U groups for age (32.2±14.1 vs. 25.3±9.6 years), open fracture ratio (35.3% vs. 11.8%), and displacement of the third fragment (13.7±6.4 vs. 9±6.3 mm). Multiple logistic regression analysis only identified displacement of the third fragment as a risk factor for delayed union (p=0.03; OR 1.13; 95% CI 1.01 to 1.26).
Delayed union was observed in 17 cases (33.3%) after intramedullary nailing of femoral shaft fractures with third fragments. Displacement of the third fragment influenced delayed union.
Level III.
本研究回顾性评估了伴有第三骨折块的股骨干骨折髓内钉固定的临床疗效，并分析了骨折延迟愈合的危险因素。
对51例伴有第三骨折块的股骨干骨折（AO分型B型35例，C型16例）行髓内钉固定的患者进行回顾性分析。延迟愈合定义为：在正位和侧位X线片观察的四个皮质骨表面中，超过三个表面骨痂形成所需时间超过10个月，或需要进行诸如更换髓内钉或骨移植等二次手术。17例患者发生延迟愈合（D组）。34例患者在9个月内实现骨愈合（U组）。比较两组间以下背景变量：受伤时年龄；AO分型；开放性骨折比例；术前等待时间；峡部以下骨折发生率；髓内钉直径；髓内钉与股骨的比例；第三骨折块的长度和移位情况；以及是否使用切开复位、阻挡螺钉或动力化。
D组和U组在年龄（32.2±14.1岁对25.3±9.6岁）、开放性骨折比例（35.3%对11.8%）和第三骨折块移位情况（13.7±6.4对9±6.3mm）方面存在显著差异。多因素逻辑回归分析仅确定第三骨折块移位是延迟愈合的危险因素（p=0.03；OR 1.13；95%CI 1.01至1.26）。
伴有第三骨折块的股骨干骨折髓内钉固定术后17例（33.3%）出现延迟愈合。第三骨折块移位影响延迟愈合。
三级。
