Karpos P A, McFerran M A, Johnson K D
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232-2550, USA.
J Orthop Trauma. 1995 Feb;9(1):57-62. doi: 10.1097/00005131-199502000-00009.
Intramedullary (IM) nails were prospectively placed in 32 consecutive femoral shaft fractures without the use of a fracture table. All fractures were reduced using manual traction. Pathologic and nonacute fractures and those requiring a reconstruction nail were excluded. The results are compared with results of two prior study groups from this institution that underwent IM nailing with or without a fracture table using a femoral distractor. Ten patients had unstable spine or pelvis fractures. Four nailings followed exploratory laparotomy. Twelve patients underwent two or more procedures on the lower extremities under the same preparation and drape. Six fractures were open. Sixty-seven percent of results were anatomic, 27% had < 5 mm lengthening/shortening or < 5 degree varus/valgus, and 7% had > 5 mm lengthening/shortening or > 5 degree varus/valgus. Average operative time was 95 min. No complications occurred that were attributable to the technique. Compared with the prior study groups, no statistical difference in the fracture types or results was found. However, operative time was significantly less in the manual traction group (p < .05). We feel that this technique is a safe, simple, and effective alternative to using a fracture table. The technique is especially useful in the polytrauma patient, significantly decreasing anesthetic time.
连续32例股骨干骨折患者前瞻性地采用髓内钉治疗，未使用骨折手术台。所有骨折均采用手法牵引复位。排除病理性骨折、非急性骨折以及需要使用重建钉的骨折。将结果与该机构之前两个研究组的结果进行比较，这两个研究组分别使用或未使用骨折手术台及股骨撑开器进行髓内钉固定。10例患者合并不稳定脊柱或骨盆骨折。4例髓内钉固定是在剖腹探查术后进行。12例患者在相同的准备和铺单下接受了下肢两次或更多次手术。6例骨折为开放性骨折。67%的骨折复位结果为解剖复位，27%的骨折延长/缩短<5 mm或内翻/外翻<5°，7%的骨折延长/缩短>5 mm或内翻/外翻>5°。平均手术时间为95分钟。未发生可归因于该技术的并发症。与之前的研究组相比，骨折类型或结果无统计学差异。然而，手法牵引组的手术时间明显更短（p<0.05）。我们认为该技术是一种安全、简单且有效的替代骨折手术台的方法。该技术在多发伤患者中尤其有用，可显著缩短麻醉时间。
