Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China.
Department of Orthopedic Surgery, Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, Jiangsu, China.
Sci Rep. 2024 Aug 6;14(1):18173. doi: 10.1038/s41598-024-69137-5.
The effect of circumference and displacement of the third fracture fragment on fracture healing after intramedullary nailing of femoral shaft fractures with a third fracture fragment was investigated. A retrospective cohort study was conducted to analyze the data of 142 patients who suffered femoral shaft fractures with a third fracture fragment and were admitted to the First People's Hospital of Lianyungang from February 2016 to December 2021. According to the circumference of the third fracture fragments, these were divided into three types of type 1: 71 cases; type 2: 52 cases; and type 3: 19 cases. On the basis of the diaphyseal diameter, the degree of displacement of the third fracture fragment was classified into three degrees of degree I: 95 cases; degree II: 31 cases; and degree III: 16 cases. Postoperative follow-up was performed to compare the fracture healing rate, healing time, and the modified Radiographic Union Scale for Tibia (mRUST) at 9th month after surgery in each group. All 142 patients were followed up after operation, with an average of (14.7 ± 4.1) months, and the overall healing rate was 73.4%. When the third fracture fragments were displaced in degree II and III, the mRUST score at 9th month in the type 1 group was higher than that in the type 2 and 3 groups (P = 0.017). Logistic regression analysis showed that greater displacement of third fracture fragments and greater circumference were associated with lower fracture healing rates (P < 0.05). After intramedullary nailing of femoral fractures, the degree of third fragment displacement and circumference affect fracture healing, and the former has a greater impact. When the third fracture fragment is displaced to degree II or III and its circumference is type 2 or type 3, it significantly affects the fracture healing. Intraoperative intervention to reduce the distance of third displacement of the fragment is required to reduce the incidence of non-union.
研究了第三骨折碎片的周长和位移对髓内钉治疗股骨干骨折伴第三骨折碎片的骨折愈合的影响。对 2016 年 2 月至 2021 年 12 月期间在连云港市第一人民医院就诊的 142 例股骨干骨折伴第三骨折碎片患者的资料进行回顾性队列研究。根据第三骨折碎片的周长，将其分为三型：1 型 71 例，2 型 52 例，3 型 19 例。基于骨干直径，将第三骨折碎片的移位程度分为三度：Ⅰ度 95 例，Ⅱ度 31 例，Ⅲ度 16 例。术后随访比较各组术后骨折愈合率、愈合时间和术后 9 个月改良胫骨放射学愈合评分（mRUST）。所有 142 例患者术后均获得随访，平均随访（14.7±4.1）个月，总体愈合率为 73.4%。当第三骨折碎片发生Ⅱ度和Ⅲ度移位时，1 型组患者术后 9 个月的 mRUST 评分高于 2 型和 3 型组（P=0.017）。Logistic 回归分析显示，第三骨折碎片的较大移位和较大周长与较低的骨折愈合率相关（P<0.05）。股骨干骨折髓内钉固定后，第三骨折片的移位程度和周长影响骨折愈合，且前者影响更大。当第三骨折片发生Ⅱ度或Ⅲ度移位，且周长为 2 型或 3 型时，明显影响骨折愈合。需要术中干预减少第三骨折片的移位距离，以降低骨不连的发生率。
