Garland D E, Rieser T V, Singer D I
Clin Orthop Relat Res. 1985 Jul-Aug(197):191-5.
Twenty-seven femoral shaft fractures in 23 patients with acute spinal cord injuries were reviewed for evaluation of the outcome of operative versus nonoperative treatment. Three groups were identified: 11 nonoperative, eight early operative, and eight delayed operative. Patients treated initially by nonoperative methods developed five impending nonunions (31%), which subsequently were treated by open reduction and internal fixation. One femur in each of the operative groups developed a refracture after early removal of metal fixation devices. In the delayed operative group, four patients (50%) required manipulation under general anesthesia for treatment of poor knee motion. Patients with complete neurologic lesions whose femurs were treated nonoperatively incurred more complications, i.e., decubitus ulcers, than those treated operatively. Operative stabilization of the femur within six weeks of injury rendered the most favorable outcome with the least number of orthopedic or medical complications in patients with both complete and incomplete cord lesions. All of the eight fractures united.
回顾了23例急性脊髓损伤患者的27例股骨干骨折，以评估手术治疗与非手术治疗的效果。分为三组：11例非手术治疗、8例早期手术治疗和8例延迟手术治疗。最初采用非手术方法治疗的患者出现了5例即将发生的骨不连（31%），随后通过切开复位内固定进行治疗。每个手术组中有1例股骨在早期取出金属固定装置后发生了再骨折。在延迟手术组中，4例患者（50%）需要在全身麻醉下进行手法治疗以改善膝关节活动度差的问题。非手术治疗股骨的完全神经损伤患者比手术治疗患者出现更多并发症，即褥疮。在损伤后六周内对股骨进行手术稳定，对于完全性和不完全性脊髓损伤患者，在骨科或内科并发症最少的情况下取得了最有利的结果。所有8例骨折均愈合。
