Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People's Hospital of Lianyungang), Lianyungang, Jiangsu Province, China.
Department of Orthopedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
J Orthop Surg Res. 2022 Aug 12;17(1):380. doi: 10.1186/s13018-022-03275-2.
To investigate the effect of the degree of displacement of a femoral shaft fracture with the third fragment on fracture healing after intramedullary nailing.
In total, 216 patients with closed comminuted femoral fracture admitted to Lianyungang Hospital affiliated to Xuzhou Medical University from February 2010 to February 2016 were analyzed retrospectively. Among these patients, 142 were males and 74 were females, the mean age was 38 years (range 17-64 years), and 95 cases were on the right, while 121 cases were on the left. All patients were treated with a femoral interlocking intramedullary nail. Referring to the femoral shaft diameter, the degree of displacement of the third fragment was classified into four grades: grade I (displacement was less than a third of the diameter of the shaft): 121 cases; grade II (greater than a third of the diameter and less than two thirds): 52 cases; grade III (greater than two thirds of the diameter): 28 cases; and grade IV (fracture fragment turnover): 15 cases. According to the modified Radiological Union Scale for Femur (mRUSF), the fracture union rate and the mean union time of the fracture, the effect of the degree of displacement of the third fragment on fracture healing was evaluated.
In total, 216 patients with a mean follow-up of 15.9 months (range 6-31 months) met the inclusion criteria. The best fracture healing was the grade I displacement, with a union rate of 89.2% and a mean union time of 7.7 months. The poorest fracture healing was for the grade IV displacement, with a union rate of 13.3% and a mean union time of 16.5 months. The healing was moderate in the grade II and III displacements, with a union rate of 46.2% and 28.6%, respectively, and a mean union time of 8.6 months and 13.5 months, respectively (P < 0.05).
The third fragment with grade I displacement requires no intervention, whereas fractures with grade IV displacement should be reduced to as near as possible to the diaphyseal bone defect to avoid nonunion. The third fragments with the grade II or III displacement should be treated with closed reduction whenever possible to achieve a displacement within the range of grade I to minimize the incidence of nonunion.
探讨股骨骨折第三骨块移位程度对髓内钉固定后骨折愈合的影响。
回顾性分析 2010 年 2 月至 2016 年 2 月徐州医科大学附属连云港医院收治的 216 例闭合性粉碎性股骨骨折患者的临床资料。其中男 142 例，女 74 例；年龄 17~64 岁，平均 38 岁；右侧 95 例，左侧 121 例。所有患者均采用股骨交锁髓内钉治疗。参照股骨干直径，将第三骨块的移位程度分为 4 级：Ⅰ级（小于干直径的 1/3）121 例，Ⅱ级（大于干直径的 1/3 小于 2/3）52 例，Ⅲ级（大于干直径的 2/3）28 例，Ⅳ级（骨折块翻转）15 例。采用改良的股骨骨折愈合Radiological Union Scale for Femur（mRUSF）评分标准评估第三骨块移位程度对骨折愈合的影响，包括骨折愈合率和骨折平均愈合时间。
216 例患者获得平均 15.9 个月（6~31 个月）的随访，均符合纳入标准。Ⅰ级骨块移位的骨折愈合最佳，愈合率为 89.2%，平均愈合时间为 7.7 个月；Ⅳ级骨块移位的骨折愈合最差，愈合率为 13.3%，平均愈合时间为 16.5 个月；Ⅱ级和Ⅲ级骨块移位的骨折愈合居中，愈合率分别为 46.2%和 28.6%，平均愈合时间分别为 8.6 个月和 13.5 个月，差异均有统计学意义（P < 0.05）。
Ⅰ级骨块移位无需干预，Ⅳ级骨块移位应尽量复位至接近骨干骨缺损，以避免骨不连。Ⅱ级和Ⅲ级骨块移位应尽可能行闭合复位，将移位程度控制在Ⅰ级以内，以减少骨不连的发生。
