Ostrum R F, DiCicco J, Lakatos R, Poka A
Orthopaedic Trauma and Reconstructive Surgery, Grant Medical Center, Columbus, Ohio 43215, USA.
J Orthop Trauma. 1998 Sep-Oct;12(7):464-8. doi: 10.1097/00005131-199809000-00006.
To prospectively evaluate the results of retrograde intramedullary nailing of femoral shaft fractures.
Prospective, consecutive series.
All patients with a femoral shaft fracture admitted at an urban Level 1 trauma center from December 1995 to December 1996 were treated with a retrograde femoral intramedullary nail.
Retrograde femoral intramedullary nailing was performed on a radiolucent operating room table. Through a three-centimeter medial parapatellar incision, a reamed ten-millimeter retrograde nail was inserted.
From the time of injury until union, the following parameters were assessed: operative time, blood loss, extent of comminution, open grade, associated injuries, Injury Severity Score, body mass index, time to union, secondary procedures, range of motion in the knee. and complications.
Fifty-seven patients with sixty-one fractures were available for follow-up, which averaged 43.1 weeks. Fifty-two percent of fractures demonstrated Winquist Type 3 or 4 comminution. Twenty-six percent of the fractures were open. Fifty-two fractures healed after the initial nailing, five of seven dynamized nails healed, and one patient with bone loss requiring bone graft united yielding a final union rate of 95 percent. Of the three nonunions (5 percent), two healed with exchange nailing and one remains asymptomatic at seventy-one weeks. One patient developed a late septic knee that resolved with treatment. Excellent range of motion in the knee was obtained by those patients who did not have other ipsilateral limb injuries.
This consecutive series had a 95 percent union rate after nailing and dynamization as necessary. No knee problems were associated with the retrograde femoral intramedullary nailing technique. The one septic knee raises concerns about the use of retrograde nailing in severe open femoral shaft fractures. Retrograde femoral nailing should be given serious consideration as an alternative to antegrade femoral nailing.
前瞻性评估股骨干骨折逆行髓内钉固定的效果。
前瞻性连续系列研究。
1995年12月至1996年12月期间，所有入住某城市一级创伤中心的股骨干骨折患者均接受了股骨逆行髓内钉治疗。
在可透X线的手术台上进行股骨逆行髓内钉固定。通过一个3厘米长的内侧髌旁切口，插入一根直径10毫米的扩髓逆行髓内钉。
从受伤至骨折愈合期间，评估以下参数：手术时间、失血量、粉碎程度、开放性骨折分级、合并伤、损伤严重度评分、体重指数、骨折愈合时间、二次手术情况、膝关节活动范围以及并发症。
57例患者共61处骨折可供随访，平均随访时间为43.1周。52%的骨折为Winquist 3型或4型粉碎性骨折。26%的骨折为开放性骨折。52处骨折在初次髓内钉固定后愈合，7枚动力化髓内钉中有5枚愈合，1例因骨缺损需植骨的患者骨折愈合，最终骨折愈合率为95%。3例骨不连患者（5%）中，2例通过更换髓内钉后愈合，1例在71周时仍无症状。1例患者出现晚期感染性膝关节，经治疗后缓解。未合并同侧肢体其他损伤的患者膝关节活动范围良好。
该连续系列研究中，经必要的髓内钉固定及动力化处理后，骨折愈合率为95%。股骨逆行髓内钉技术未引发膝关节问题。1例感染性膝关节病例引发了对严重开放性股骨干骨折逆行髓内钉使用的担忧。股骨逆行髓内钉作为顺行股骨髓内钉的替代方法应予以认真考虑。
