Webb L X, Gristina A G, Fowler H L
Department of Surgery, Wake Forest University Medical Center, Winston-Salem, North Carolina.
J Orthop Trauma. 1988;2(1):10-2.
Among 60 femur fractures not amenable to fixation by simple intramedullary nailing, 30 were treated with balanced skeletal traction followed by cast bracing or spica casting, and 30 were treated with closed interlocking nailing. The criteria for using an interlocking nail were fractures with less than 50% cortical contact or fractures with rotationally insecure purchase of the nail in either the proximal or distal fragment. In terms of fracture severity, patient age, injury severity, and clinical follow-up, the patient groups were similar. There were three open fractures in each group. The average hospital stay was 61 days for the traction group, and 19 days for the interlocking nail group (p less than 0.001). Time to clinical and radiographic union averaged 34 weeks with traction and casting and 18 weeks with interlocking nail fixation (p less than 0.001). Failure by the criteria of Johnson et al (2) occurred in 67% of the traction group and in 3% of the interlocking nail group (p less than 0.001). Minor complications were more common in the traction group. On the basis of this study and the experience of others, interlocking nail fixation appears to be the method of choice for managing unstable femoral shaft fractures.
在60例无法通过简单髓内钉固定治疗的股骨骨折患者中，30例接受了平衡骨骼牵引，随后进行管型支具或髋人字石膏固定，另外30例接受了闭合交锁髓内钉固定。使用交锁髓内钉的标准为皮质骨接触小于50%的骨折，或交锁髓内钉在近端或远端骨折块中旋入不稳定的骨折。在骨折严重程度、患者年龄、损伤严重程度及临床随访方面，两组患者相似。每组均有3例开放性骨折。牵引组的平均住院时间为61天，交锁髓内钉组为19天（p<0.001）。牵引加石膏固定达到临床及影像学愈合的平均时间为34周，交锁髓内钉固定为18周（p<0.001）。按照约翰逊等人（2）的标准，牵引组的失败率为67%，交锁髓内钉组为3%（p<0.001）。牵引组的轻微并发症更为常见。基于本研究及其他研究经验，交锁髓内钉固定似乎是治疗不稳定股骨干骨折的首选方法。
