Uhlin B, Hammer R
Department of Orthopedic Surgery, University Hospital, Linköping, Sweden.
Acta Orthop Scand. 1998 Jun;69(3):301-5. doi: 10.3109/17453679809000935.
We evaluated the possibility of unreamed insertion of an intramedullary nail (IMN) in a consecutive series of 55 tibial shaft fractures in 55 patients (30 men). 43 fractures were closed and 12 fractures were open. All surgeons involved were instructed to try unreamed insertion primarily. Selection of nail diameter was based on measurements of the narrowest part of the medullary canal on preoperative AP- and lateral radiographs, with a millimeter-ruler. Of the 25 cases where a 9 mm nail was chosen, 10 were impossible to insert without reaming. An 8 mm nail was selected in the remaining 30 cases, and here 10 required reaming. Mean time-to-union was 4.2 months. Delayed union was noted in 9 patients of whom 6 had been stabilized with an unreamed nail. The concept of unreamed insertion must be questioned since this could be done in only 35 patients and, in addition, we were not able to demonstrate any significant differences in time-to-union in fractures stabilized with an unreamed or a reamed nail. Implant failures were seen in 5 patients, all stabilized with an 8 mm nail. Failure of interlocking screws did not affect the final outcome. However, a possible combination of screw breakage and healing disturbances may lead to the need for more complex surgical procedures. Due to these reasons and the fact that the 8 mm nail could not be inserted unreamed in 10 of 30 patients, we stopped using the 8 mm nail.
我们评估了在55例胫骨干骨折患者（30例男性）中连续进行非扩髓髓内钉（IMN）置入的可能性。43例骨折为闭合性骨折，12例为开放性骨折。所有参与的外科医生均被指示首先尝试非扩髓置入。根据术前正位和侧位X线片上用毫米尺测量的髓腔最窄部位来选择钉的直径。在选择9毫米钉的25例病例中，有10例不扩髓无法置入。其余30例选择了8毫米钉，其中10例需要扩髓。平均愈合时间为4.2个月。9例患者出现延迟愈合，其中6例采用非扩髓钉固定。非扩髓置入的概念值得质疑，因为只有35例患者能够做到这一点，此外，我们未能证明非扩髓或扩髓固定的骨折在愈合时间上有任何显著差异。5例患者出现植入物失败，均采用8毫米钉固定。交锁螺钉失败并不影响最终结果。然而，螺钉断裂和愈合障碍的可能组合可能导致需要更复杂的手术操作。由于这些原因以及30例患者中有10例无法非扩髓置入8毫米钉这一事实，我们停止使用8毫米钉。
