股骨干骨折的一期动力交锁髓内钉:病例系列

Primary dynamic interlocking nail in femoral shaft fracture: A case series.

作者信息

Luthfi Andi Praja Wira Yudha, Hendarji Adlan, Dalitan Ivan Mucharry, Wedhanto Sigit

机构信息

Department of Orthopaedic and Traumatology, Bhayangkara Tk.I R. Said Sukanto Police Hospital, Jakarta, Indonesia.

Bhayangkara Tk.I R. Said Sukanto Police Hospital, Jakarta, Indonesia.

出版信息

Int J Surg Case Rep. 2023 Apr;105:108051. doi: 10.1016/j.ijscr.2023.108051. Epub 2023 Mar 24.

Abstract

INTRODUCTION AND IMPORTANCE

Femoral shaft fracture is one of the most frequent injuries encountered by an orthopedic surgeon. Surgical treatment is commonly needed. Intramedullary nailing remains the gold-standard in surgical treatment of femoral shaft fracture. One of the constant dilemmas in intramedullary nailing is whether to use a static or dynamic locking screw for treating femoral shaft fractures.

CASE PRESENTATION

We reported three cases of simple femoral shaft fracture and surgically fixed with primary dynamic interlocking nail. Closed reduction with reamed nail was performed in 2 cases, and mini open reduction with un-reamed nail was performed to the other one. Early weight bearing was instructed at day 1 post-operative. Mean follow-up period was 12.6 months. A solid bony union was achieved by all patients, and no complications were observed at the final follow up.

CLINICAL DISCUSSION

Intramedullary nailing can be made static or dynamic. It is thought that in static mode of the intramedullary nailing, the axial weight is transferred through the locking screws rather than the fracture site, thus altering the callus formation and delaying fracture healing. A prompt dynamization of the fragments allows the contact of both fragments during mobilization and promotes early callus formation.

CONCLUSION

Primary dynamic interlocking nail is an effective option for surgical treatment in simple or short oblique femoral shaft fracture.

摘要

引言与重要性

股骨干骨折是骨科医生最常遇到的损伤之一,通常需要手术治疗。髓内钉固定仍是股骨干骨折手术治疗的金标准。髓内钉固定中一个持续存在的难题是,治疗股骨干骨折时是使用静态锁定螺钉还是动态锁定螺钉。

病例介绍

我们报告了3例单纯股骨干骨折病例,均采用一期动力交锁髓内钉进行手术固定。其中2例行闭合复位扩髓髓内钉固定,另1例行小切口切开复位非扩髓髓内钉固定。术后第1天即指导患者早期负重。平均随访时间为12.6个月。所有患者均实现了牢固的骨愈合,末次随访时未观察到并发症。

临床讨论

髓内钉固定可分为静态和动态两种方式。人们认为,在髓内钉固定的静态模式下,轴向负荷通过锁定螺钉而非骨折部位传递,从而改变骨痂形成并延迟骨折愈合。对骨折块及时进行动力化处理可使骨折块在活动过程中相互接触,并促进早期骨痂形成。

结论

一期动力交锁髓内钉是治疗单纯性或短斜形股骨干骨折的一种有效手术选择。

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