Moed B R, Watson J T
Department of Orthopaedic Surgery, K-12, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA.
J Bone Joint Surg Am. 1995 Oct;77(10):1520-7. doi: 10.2106/00004623-199510000-00006.
Twenty consecutive multiply injured patients who had a total of twenty-two fractures of the femoral shaft were managed with intramedullary nailing without reaming. A retrograde technique through the intercondylar notch of the knee was used. All patients were followed for at least one year or until union of the fracture. The operative time for the nailing averaged seventy-five minutes (range, thirty-five to 105 minutes). Union of the fracture occurred at an average of fifteen weeks. There were three non-unions and one rotational malunion. There were no infections, and no nail or screw failed. Normal motion of the knee was regained by all patients, except one who had had an ipsilateral dislocation of the knee. On the basis of these preliminary results, we concluded that retrograde nailing is a safe and effective technique for multiply injured patients. The apparently higher prevalence of non-union compared with that reported with antegrade nailing with reaming warrants additional study.
20例连续的多发伤患者共有22处股骨干骨折，采用非扩髓髓内钉固定治疗。采用经膝关节髁间切迹的逆行技术。所有患者均随访至少1年或直至骨折愈合。髓内钉固定的手术时间平均为75分钟（范围为35至105分钟）。骨折平均在15周时愈合。有3例骨不连和1例旋转畸形愈合。无感染发生，无髓内钉或螺钉失效。除1例同侧膝关节脱位的患者外，所有患者均恢复了膝关节的正常活动。基于这些初步结果，我们得出结论，逆行髓内钉固定术对于多发伤患者是一种安全有效的技术。与顺行扩髓髓内钉固定术相比，骨不连的发生率明显较高，这值得进一步研究。
