Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Republic of Korea.
Biomed Res Int. 2019 May 8;2019:9412379. doi: 10.1155/2019/9412379. eCollection 2019.
Intramedullary nails have been the treatment of choice for acute femur-shaft fractures in adults. However, the infraisthmal location has a high risk of nonunion and is easy to malalign. This study evaluated radiologic outcomes of initial supportive use of poller screws in combination with antegrade femoral nailing in infraisthmal femur-shaft fracture.
A total of 49 patients who had undergone antegrade nailing with or without supportive poller-screw insertion for infraisthmal femur-shaft fracture were included in this retrospective cohort study (23 patients with poller screws in group 1 versus 26 patients without poller screws in group 2). Patient demographics including sex, age, classification, mechanism of injury, operative time, poller-screw time, and radiologic outcomes, including union rate, time to union, and number of malunions, were evaluated.
Union rate in group 1 (95.6%) was significantly higher than that in group 2 (84.6%) ( = 0.04). Time to union was 19.8 weeks in group 1 and 20.3 weeks in group 2 ( = 0.31).
Initial supportive insertion of two poller screws after nailing took a mean of 21minutes additionally but could lessen the risk of nonunion significantly in this study. We believe that these findings may have important clinical relevance for the treatment of infraisthmal femur-shaft fracture.
髓内钉一直是成人股骨干急性骨折的首选治疗方法。然而，在坐骨下支区域骨折，骨折不愈合的风险较高，且容易发生畸形愈合。本研究评估了在坐骨下支区域股骨干骨折中，初始使用附加拉力螺钉辅助顺行股骨髓内钉治疗的放射学结果。
本回顾性队列研究共纳入 49 例接受顺行髓内钉固定并附加或不附加拉力螺钉治疗坐骨下支区域股骨干骨折的患者（附加拉力螺钉 23 例，记为组 1；未附加拉力螺钉 26 例，记为组 2）。评估患者的人口统计学资料，包括性别、年龄、骨折类型、损伤机制、手术时间、附加拉力螺钉时间以及放射学结果，包括愈合率、愈合时间和畸形愈合的数量。
组 1 的愈合率（95.6%）显著高于组 2（84.6%）（ = 0.04）。组 1 的愈合时间为 19.8 周，组 2 的愈合时间为 20.3 周（ = 0.31）。
本研究中，附加 2 枚拉力螺钉辅助顺行髓内钉固定平均额外增加 21 分钟的手术时间，但能显著降低骨折不愈合的风险。我们认为这些发现对坐骨下支区域股骨干骨折的治疗具有重要的临床意义。
