Cao Tao-Yi, Chen Zhi-da, Ding Zhen-Qi, Song Chao, Huang Guo-Feng, Hu Xiao-Yang, Huang Jia-Ping
Department of Orthopaedics, the 909th Hospital of People's Liberation Army, Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of PLA, Zhangzhou 363000, Fujian, China.
Zhongguo Gu Shang. 2021 Oct 25;34(10):965-70. doi: 10.12200/j.issn.1003-0034.2021.10.015.
To summarize the complications of core drilling intramedullary nail in the treatment of femoral shaft closed fracture and explore the treatment strategy.
From August 2014 to June 2018, a total of 215 patients with closed femoral shaft fractures were treated with closed reduction core drill intramedullary nail, including 129 males and 86 females, aged from 18 to 62 years, with an average of (44.2±10.6) years old. The time from injury to operation was 3 to 21 days. There were 102 cases of AO type A fracture, 82 cases of AO type B fracture and 31 cases of AO type C fracture. The time of operation, the amount of blood loss during operation, the duration of hospitalization, the time of fracture healing and the HSS score of knee joint function at the last follow-up were recorded. The observation of complications included:iatrogenic fracture, core drill broken, core drill twist, postoperative infection, and fracture nonunion.
The average operation time was (63.2± 15.6) min and intraoperative blood loss was (150.0±34.5) ml. All the incisions reached grade A healing. Patients were follow up for a mean of (18.5±3.2) months, the average hospital stay was (4.3±1.2) days, and the average fracture healing time was (5.6±2.3) months. At the final follow-up, the average HSS score of knee joint was 90.3±4.7. Related complications occurred in 37 cases (17.2%). The core drill related complications occurred in 13 cases (6.0%), including core drill broken in 5 cases (2.3%), core removal in 1 case and slotting in 4 cases;core drill twist in 8 cases (3.7%). After the core was cut, the core was removed. Similar complicationsof conventional intramedullary nail:iatrogenic fracture was performed in 12 cases (5.6%), including 10 cases of fracture end split and 2 cases of distal perimedullary fracture of intramedullary nail. The patients with cleavage at the fracture end were not treated after judging their stability, and the patients with fracture around the distal end of the intramedullary nail were fixed with auxiliary steel plate during operation;1 case(0.4%) with delayed infection after operation, debridement and external fixation was replaced and healed after bone transfer; fracture nonunion occurred in 11 cases (5.1%), of which 7 cases (3.3%) were hypertrophic nonunion and healed with additional plate. Atrophic nonunion occurred in 4 cases (1.9%), which healed after additional steel plate and bone graft.
Core drilling intramedullary nail is an effective method for the treatment of closed femoral shaft fracture, and the complications include core drill related complications and conventional intramedullary nail similar complications. Accurate preoperative evaluation, careful operation during operation and early postoperative symptomatic treatment can effectively reduce the occurrence of related complications.
总结髓芯减压交锁髓内钉治疗股骨干闭合性骨折的并发症，并探讨其治疗策略。
选取2014年8月至2018年6月采用闭合复位髓芯减压交锁髓内钉治疗的215例股骨干闭合性骨折患者，其中男129例，女86例；年龄18～62岁，平均（44.2±10.6）岁。受伤至手术时间为3～21天。AO分型：A型102例，B型82例，C型31例。记录手术时间、术中出血量、住院时间、骨折愈合时间及末次随访时膝关节功能HSS评分。观察并发症包括：医源性骨折、髓芯折断、髓芯扭曲、术后感染、骨折不愈合。
平均手术时间为（63.2±15.6）分钟，术中出血量为（150.0±34.5）毫升。所有切口均甲级愈合。患者平均随访（18.5±3.2）个月，平均住院时间为（4.3±1.2）天，平均骨折愈合时间为（5.6±2.3）个月。末次随访时膝关节平均HSS评分为90.3±4.7。发生相关并发症37例（17.2%）。髓芯相关并发症13例（6.0%），其中髓芯折断5例（2.3%），髓芯取出1例，开槽4例；髓芯扭曲8例（3.7%）。髓芯切断后取出髓芯。传统髓内钉类似并发症：医源性骨折12例（5.6%），其中骨折端劈裂10例，髓内钉远端周围骨折2例。骨折端劈裂患者经判断稳定性后未处理，髓内钉远端周围骨折患者术中用辅助钢板固定；术后迟发性感染1例（0.4%），清创后更换外固定架，骨搬运后愈合；骨折不愈合11例（5.1%），其中肥大性不愈合7例（3.3%），加用钢板后愈合。萎缩性不愈合4例（1.9%），加用钢板及植骨后愈合。
髓芯减压交锁髓内钉是治疗股骨干闭合性骨折的有效方法，并发症包括髓芯相关并发症及传统髓内钉类似并发症。术前准确评估、术中仔细操作及术后早期对症处理可有效减少相关并发症的发生。
