Koval K J, Seligson D, Rosen H, Fee K
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, New York 10003, USA.
J Orthop Trauma. 1995;9(4):285-91. doi: 10.1097/00005131-199509040-00003.
Between March 1989 and August 1993, 16 distal femoral nonunions (16 patients) were treated using the supracondylar intramedullary nail. The time between the initial event and retrograde nailing averaged 33 months. The nonunion level was infraisthmal in four patients and supracondylar in 12. Operative technique involved retrograde insertion of a reamed supracondylar intramedullary nail through the intercondylar notch. Follow-up was available on all patients and averaged 20 months (range 9-46). Four nonunions (25%) united with a single surgery at an average of 17 months. A fifth nonunion united at 21 months after nail dynamization and subsequent nail breakage. The nonunions of two additional patients united after exchange of a broken retrograde nail. Additional surgical procedures were performed in six of the remaining nine patients in an attempt to gain union. At an average follow-up of 16 months (range 9-23), none of the nine had united. Nine nails fractured at an average of 11 months, all through a screw hole near the nonunion. Based on these results, we cannot recommend use of the supracondylar intramedullary nail in its present form for the treatment of distal femoral nonunions.
1989年3月至1993年8月期间，采用髁上髓内钉治疗了16例股骨远端骨不连（16例患者）。初次受伤至逆行穿钉的平均时间为33个月。4例患者的骨不连位于峡部以下，12例位于髁上。手术技术包括通过髁间切迹逆行插入扩髓的髁上髓内钉。所有患者均获得随访，平均随访时间为20个月（9 - 46个月）。4例骨不连（25%）经一次手术愈合，平均愈合时间为17个月。第5例骨不连在髓内钉动力化及随后髓内钉断裂后于21个月愈合。另外2例患者在更换断裂的逆行髓内钉后骨不连愈合。其余9例患者中有6例进行了额外的手术以促进愈合。平均随访16个月（9 - 23个月）时，这9例患者均未愈合。9枚髓内钉平均在11个月时断裂，均通过靠近骨不连处的螺钉孔。基于这些结果，我们不推荐使用目前形式的髁上髓内钉治疗股骨远端骨不连。
