Danziger M B, Caucci D, Zecher S B, Segal D, Covall D J
Boston City Hospital, Massachusetts, USA.
Am J Orthop (Belle Mead NJ). 1995 Sep;24(9):684-90.
From April 1990 to August 1994, the GSH supracondylar intramedullary nail (Smith & Nephew/Richards, Memphis, Tennessee) was used to treat 23 supracondylar femur fractures in 22 patients. Nineteen of the 23 fractures were highly comminuted and intra-articular. Fifteen patients with 16 fractures were followed up to healing or declaration of nonunion for an average of 10 months. All fractures were treated with direct reduction through a median parapatellar incision. Fixation of the intercondylar fractures was with 6.5-mm cannulated screws, and the GSH nail was then inserted between the screws to secure the articular segment to the shaft. Fifteen of the 16 fractures healed (94%) with excellent and good results at an average of 3.3 months. Initial postoperative fracture reduction was maintained in all patients until union, as shown by follow-up radiographs. Thirteen of the 16 patients were treated with immediate continuous passive motion of the knee. Average knee range-of-motion was 109 degrees. Complications included 1 nonunion, 1 delayed union, 1 hardware failure secondary to premature full weight-bearing, and 1 patient with impingement of the nail in the intercondylar notch. This impingement resolved with removal of the nail after fracture healing. The GSH supracondylar intramedullary nail is an excellent alternative for the treatment of supracondylar and intercondylar femur fractures.
1990年4月至1994年8月，采用GSH髁上髓内钉（史赛克公司/理查兹公司，田纳西州孟菲斯）治疗22例患者的23例股骨髁上骨折。23例骨折中有19例为高度粉碎性关节内骨折。15例患者的16处骨折获得随访，直至骨折愈合或判定为骨不连，平均随访时间为10个月。所有骨折均通过髌旁正中切口进行直接复位。髁间骨折采用6.5mm空心螺钉固定，然后在螺钉之间插入GSH髓内钉，将关节段固定于骨干。16处骨折中有15处（94%）愈合，平均3.3个月时效果优良。随访X线片显示，所有患者术后骨折初始复位情况均维持至骨折愈合。16例患者中有13例术后立即进行膝关节持续被动活动。膝关节平均活动范围为109度。并发症包括1例骨不连、1例延迟愈合、1例因过早完全负重导致的内固定失败以及1例髓内钉在髁间切迹处撞击。骨折愈合后取出髓内钉，撞击情况得以解决。GSH髁上髓内钉是治疗股骨髁上和髁间骨折的极佳选择。
