Orthopaedic Department, El-Eman General Hospital, Assiut, Egypt.
Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, Egypt.
J Orthop Surg Res. 2023 Oct 29;18(1):808. doi: 10.1186/s13018-023-04300-8.
The primary objective of the current study is to assess which is better for obtaining the proper femoral rotation during IMN of femoral fractures, the radiological or clinical method. The secondary objectives were to document malrotation's incidence and its effect on the hip and knee functional outcomes.
Thirty-three patients with unilateral femoral shaft fractures were treated using intramedullary nails (IMN) on a usual radiolucent operative table. Intraoperative rotation adjustment was performed using a radiological method (relying on the contralateral lesser trochanter profile) in 16 patients (group A), while in 17 patients, a clinical method was used (group B). Postoperative assessment of malrotation was performed using a CT scan, and 15 degrees was the cutoff value where below is an acceptable rotation (group I) and above is true malrotation (group II). Functional assessment was performed using the Harris hip score (HHS), the Tegner Lysholm Knee Scoring Scale (TLKSS), and the Neer score.
The patients' mean age was 30.7 ± 9.3 years; 81.8% were males, and the left side was injured in 63.6% of patients. After a mean follow up of 18.2 ± 6.9 months, all fractures were united, and the overall mean amount of rotational difference between the fractured and the contralateral side was 14.7° ± 6.0 (3-29.4), 84.8% were in external rotation. No difference in the mean rotational deformity in group A compared to group B. Measurements were 13.9 ± 6.7 and 15.7 ± 5.5, respectively (p = 0.47). Seventeen (51.5%) patients in group I with a mean deformity of 9.8 ± 3.4 (3-14.7), while group II consisted of 16 (48.5%) patients with a mean deformity of 19.6 ± 3.7 (15.3-29.4). There was no difference in the functional scores between group I and group II; HHS was 89.4 ± 7.4 versus 87.7 ± 8.9 (p = 0.54), TLKSS was 84.6 ± 9.6 versus 80.4 ± 13.9 (p = 0.32), and Neer score was 87.9 ± 9.5 versus 83 ± 12.5 (p = 0.21) for group I and group II, respectively.
There was no difference in malrotation incidence after unilateral femoral fractures IMN with either an intraoperative clinical or radiological method for rotational adjustment; furthermore, malrotation did not affect the functional outcomes.
本研究的主要目的是评估在髓内钉（IMN）治疗股骨干骨折时，哪种方法（影像学方法或临床方法）更有利于获得正确的股骨旋转。次要目的是记录旋转不良的发生率及其对髋关节和膝关节功能结果的影响。
33 例单侧股骨干骨折患者在普通透视手术台上使用髓内钉（IMN）治疗。16 例患者（A 组）采用影像学方法（依靠对侧小转子轮廓）进行术中旋转调整，17 例患者（B 组）采用临床方法。术后采用 CT 扫描评估旋转不良，15 度为可接受旋转（I 组）和真性旋转不良（II 组）的截断值。功能评估采用 Harris 髋关节评分（HHS）、Tegner Lysholm 膝关节评分量表（TLKSS）和 Neer 评分。
患者平均年龄为 30.7±9.3 岁；81.8%为男性，左侧受伤占 63.6%。平均随访 18.2±6.9 个月后，所有骨折均愈合，骨折侧与对侧的旋转总差异平均为 14.7°±6.0（3-29.4），84.8%为外旋。A 组与 B 组的平均旋转畸形无差异。测量值分别为 13.9±6.7 和 15.7±5.5（p=0.47）。I 组 17 例（51.5%）患者的平均畸形为 9.8±3.4（3-14.7），II 组 16 例（48.5%）患者的平均畸形为 19.6±3.7（15.3-29.4）。I 组和 II 组的功能评分无差异；HHS 分别为 89.4±7.4 与 87.7±8.9（p=0.54），TLKSS 分别为 84.6±9.6 与 80.4±13.9（p=0.32），Neer 评分分别为 87.9±9.5 与 83±12.5（p=0.21）。
在单侧股骨干骨折的髓内钉治疗中，采用术中临床或影像学方法进行旋转调整，旋转不良的发生率无差异；此外，旋转不良并不影响功能结果。
