Kolmert L, Persson B M, Romanus B
Clin Orthop Relat Res. 1982 Nov-Dec(171):290-9.
Tibial traction for distal femoral fractures, followed after four to eight weeks by plaster, is the common treatment. Because of improved methodology, the proportion of surgically treated fractures had increased. Stable osteosynthesis with different plates is an established therapy for distal femoral fractures. In elderly or other patients with bone fragility, however, these operations often fail. The majority of the distal femoral fractures occur in such patients, and traction in bed is therefore often used. A less rigid device was constructed to meet the special circumstances with bone fragility. This device consists of two Ender's nails: one is inserted from each condyle, and each is connected to two cancellous screws traversing both condyles. The strength of this semielastic osteosynthesis was compared with four existing devices (AO, Rush, Zickel, Ender). Fixation was carried out in 17 pairs of osteotomized postmortem preparations from patients older than 60 years of age. The specimens were submitted to constant bending rate, and the load deformation was registered. The fixation with the condylar plate was strongest and showed the lowest flexibility. The Ender's nails and the Rush pins showed a tendency to lose their Condylar stabilization early. This was less pronounced with the Zickel nail, which, however, tended to displace at the osteotomy site during insertion and fracture the proximal fragment due to the limited bending ability of the blade construction. The new, semielastic device (ECS) was constructed to meet the special circumstances with bone fragility. It consists of two cancellous screws traversing both condyles. It combined easy insertion with moderate flexibility and high residual strength. In extension, it deflected 40 degrees without influencing residual stability. It is an interesting alternative to rigid internal fixation or traction in bed for osteoporotic patients with distal femoral fractures. In combines rigid screw fixation in the condylar part with an elastic adjustment in the femoral shaft above.
对于股骨远端骨折，通常的治疗方法是先进行胫骨牵引，四至八周后再使用石膏固定。由于治疗方法的改进，手术治疗骨折的比例有所增加。使用不同钢板进行稳定的骨固定术是治疗股骨远端骨折的既定疗法。然而，在老年患者或其他骨质脆弱的患者中，这些手术常常失败。大多数股骨远端骨折发生在这类患者身上，因此经常采用床上牵引的方法。为满足骨质脆弱的特殊情况，设计了一种刚性较小的装置。该装置由两根恩德斯钉组成：分别从每个髁插入，每根钉与两根穿过两个髁的松质骨螺钉相连。将这种半弹性骨固定术的强度与四种现有装置（AO、拉什针、齐克尔钉、恩德斯钉）进行了比较。在17对取自60岁以上患者的死后截骨标本上进行固定。对标本施加恒定的弯曲速率，并记录载荷变形情况。髁钢板固定最强，柔韧性最低。恩德斯钉和拉什针显示出早期失去髁稳定的趋势。齐克尔钉的这种情况不太明显，然而，由于刀片结构的弯曲能力有限，齐克尔钉在插入过程中往往在截骨部位移位，并导致近端骨折块骨折。新的半弹性装置（ECS）是为满足骨质脆弱的特殊情况而设计的。它由两根穿过两个髁的松质骨螺钉组成。它兼具易于插入、适度柔韧性和较高残余强度的特点。在伸展时，它可偏转40度而不影响残余稳定性。对于患有股骨远端骨折的骨质疏松患者，它是刚性内固定或床上牵引的一种有趣替代方法。它将髁部的刚性螺钉固定与股骨骨干上方的弹性调节相结合。
