Retrograde and anterograde intramedullary nailing in treating midshaft fracture of femoral shaft
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摘要:目的
观察逆行股骨髓内钉和顺行股骨髓内钉治疗股骨干中段骨折的疗效和并发症。
方法选取股骨干中段骨折患者76例纳入本研究，根据主钉置入方式的不同，分为逆行组36例和顺行组40例。比较2组围术期、随访及并发症情况。
结果2组患者髓内钉直径、透视次数、骨折两端螺钉数量比较，差异无统计学意义(P＞0.05); 逆行组手术时间短于顺行组，而出血量多于顺行组，差异有统计学意义(P＜0.05)。末次随访时2组患者骨折愈合时间、Harris评分、Lysholm评分、骨折愈合率比较，差异无统计学意义(P＞0.05)。顺行组膝关节屈曲度为(130.22±4.31)°, 优于逆行组的(126.58±8.41)°, 逆行组患者膝关节疼痛发生率(19.4%)高于顺行组(2.5%), 差异有统计学意义(P＜0.05)。
结论逆行髓内钉和顺行髓内钉治疗股骨干中段骨折均可取得较满意的临床疗效，逆行置钉无需牵引床，相对便捷，但逆行钉固定后膝关节并发症相对较多。
Abstract:ObjectiveTo observe the efficacy and complications of retrograde femoral intramedullary nailing and anterograde femoral intramedullary nailing in the treatment of midshaft fracture of femoral shaft.
MethodsA total of 76 patients with middle femoral shaft fracture were included in this study. According to the different placement methods of main screws, they were divided into retrograde group (36 cases) and anterograde group (40 cases). The conditions of perioperation, during follow-up and occurrence of complications of the two groups were compared.
ResultsThere were no significant differences in diameter of intramedullary nail, the number of fluoroscopy, the number of screws at both ends of fracture between the two groups (P > 0.05). In the retrograde group, the operation time was shorter than that in the anterograde group, and amount of bleeding was more than that in the anterograde group (P < 0.05). At the last follow-up, there were no significant differences in fracture healing time, Harris score, Lysholm score and fracture healing rate between the two groups (P > 0.05). The knee flexion degree in the anterograde group was (130.22±4.31)°, which was better than (126.58±8.41)° in the retrograde group, and the incidence of knee pain in the retrograde group was 19.4%, which was significantly higher than 2.5% in the anterograde group (P < 0.05).
ConclusionBoth retrograde intramedullary nail and anterograde intramedullary nail can achieve satisfactory clinical effects in the treatment of middle femoral shaft fractures. Retrograde nail placement is relatively convenient without traction bed, but there are relatively more complications in knee joint after retrograde nail fixation.
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图 1 典型病例经左股骨大粗隆顺行髓内钉治疗
A: 术前X线片显示左股骨干峡部骨折，可见分离骨块; B: 术后第7天X线片，显示骨折对位对线良好; C: 术后第12周X线片，显示断端骨痂生长，骨折线模糊; D: 术后第36周X线片，骨折端愈合良好; E: 术后第14个月，左股骨髓内钉取出术后。
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图 2 典型病例经股骨髁逆行髓内钉治疗
A: 术前X线片，显示左股骨峡部下合并左髌骨骨折，断端短缩分离移位; B: 术后第14天X线片，显示骨折对位对线良好; C: 术后第14周X线片，显示少量连续性骨痂通过骨折线; D: 术后第40周X线片，骨折断端未完全愈合，行取出股骨骨折近端螺钉动力化促进断端愈合; E: 取出近端螺钉术后第12周显示骨折线模糊，可见连续性骨痂通过; F: 取出近端螺钉术后第20周显示骨折端愈合良好。<
表 1 2组患者一般资料比较(x±s)[n(%)]
一般资料 分类 逆行组(n=36) 顺行组(n=40) 性别 男 24(66.67) 28(70.00) 女 12(33.33) 12(30.00) 年龄/岁 42.21±20.35 40.22±16.58 侧别 左 19(52.78) 17(42.50) 右 17(47.22) 23(57.50) 吸烟史 12(33.33) 16(40.00) 饮酒史 9(25.00) 12(30.00) 体质量指数/(kg/m2) 23.91±1.12 24.31±0.82 开放性骨折 5(13.89) 6(15.00) 受伤至手术时间/d 3.80±2.60 4.50±1.80 受伤原因 交通事故 12(33.33) 20(50.00) 高处坠落 15(41.67) 11(27.50) 重物砸伤 9(25.00) 9(22.50) AO分型 A型 15(41.67) 17(42.50) B型 13(36.11) 16(40.00) C型 8(22.22) 7(17.50) 
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表 2 2组患者围术期情况比较(x±s)
指标 逆行组(n=36) 顺行组(n=40) 手术时间/min 86.70±5.33 101.66±7.54* 出血量/mL 130.00±9.35 120.60±6.25* 透视次数/次 10.08±2.65 10.04±1.70 髓内钉直径/mm 10.00±1.09 10.21±1.21 螺钉数量/个 4.66±1.06 4.96±0.80 与逆行组比较, *P＜0.05。
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表 3 2组术后随访情况比较(x±s)
指标 逆行组(n=36) 顺行组(n=40) 骨折愈合时间/周 15.26±2.11 14.78±3.51 Harris评分/分 93.17±6.38 91.33±7.14 Lysholm评分/分 93.52±4.53 94.10±5.71 膝关节屈曲度/° 126.58±8.41 130.22±4.31* 与逆行组比较, *P＜0.05。
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[1] MEMARZADEH A, TISSINGH E K, HULL P, et al. Intramedullary nailing of femoral shaft fractures in adults[J]. Orthop Trauma, 2017, 31(2): 86-92. doi: 10.1016/j.mporth.2016.11.001
[2] 王秋根. 髓内钉固定治疗成人股骨干骨折的相关问题[J]. 中华创伤杂志, 2017, 33(1): 6-9. doi: 10.3760/cma.j.issn.1001-8050.2017.01.003 [3] RICCI W M, BELLABARBA C, EVANOFF B, et al. Retrograde versus antegrade nailing of femoral shaft fractures[J]. J Orthop Trauma, 2001, 15(3): 161-169. doi: 10.1097/00005131-200103000-00003
[4] HUSSAIN N, HUSSAIN F N, SERMER C, et al. Antegrade versus retrograde nailing techniques and trochanteric versus piriformis intramedullary nailing entry points for femoral shaft fractures: a systematic review and meta-analysis[J]. Can J Surg, 2017, 60(1): 19-29.
[5] RICCI W M, GALLAGHER B, HAIDUKEWYCH G J. Intramedullary nailing of femoral shaft fractures: current concepts[J]. J Am Acad Orthop Surg, 2009, 17(5): 296-305. doi: 10.5435/00124635-200905000-00004
[6] TESTA G, VESCIO A, ALOJ D C, et al. Definitive treatment of femoral shaft fractures: comparison between anterograde intramedullary nailing and monoaxial external fixation[J]. J Clin Med, 2019, 8(8): 1119. doi: 10.3390/jcm8081119
[7] 陶勇, 江渟, 田克超. 芯钻远端锁定系统在髓内钉治疗股骨干骨折中的作用[J]. 中国组织工程研究, 2019, 23(36): 5800-5805. doi: 10.3969/j.issn.2095-4344.1436 [8] SWIONTKOWSKI M F, HANSEN S T Jr, KELLAM J. Ipsilateral fractures of the femoral neck and shaft. A treatment protocol[J]. J Bone Joint Surg Am, 1984, 66(2): 260-268. doi: 10.2106/00004623-198466020-00013
[9] SANDERS R, KOVAL K J, DIPASQUALE T, et al. Retrograde reamed femoral nailing[J]. J Orthop Trauma, 2014, 28(Suppl 8): S15-S24.
[10] 桂鹏, 邹毅, 冷华伟, 等. 闭合与开放髓内钉治疗股骨干骨折比较[J]. 中国矫形外科杂志, 2020, 28(22): 2027-2031. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS202022005.htm [11] SALEM K H, MAIER D, KEPPLER P, et al. Limb malalignment and functional outcome after antegrade versus retrograde intramedullary nailing in distal femoral fractures[J]. J Trauma, 2006, 61(2): 375-381. doi: 10.1097/01.ta.0000230282.65606.81
[12] METSEMAKERS W J, ROELS N, BELMANS A, et al. Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: remaining controversies[J]. Injury, 2015, 46(8): 1601-1607. doi: 10.1016/j.injury.2015.05.007
[13] PETTETT B J, AVERY M C, OSTRUM R F. Retrograde femoral nailing using percutaneous reduction techniques[J]. J Orthop Trauma, 2017, 31(Suppl 3): S6-S7.
[14] 桂景雄, 邓志成, 朱小华, 等. 有限切开复位在髓内钉治疗股骨干骨折中的应用评价[J]. 中国医师进修杂志, 2020, 43(3): 265-270. doi: 10.3760/cma.j.issn.1673-4904.2020.03.017 [15] YOON R S, ADAMS D M, SEIGERMAN D A, et al. Impact of surrounding canal size on time to union after intramedullary nailing of femur fractures: are 10-mm nails all we need[J]. J Orthop Trauma, 2020, 34(4): 180-185. doi: 10.1097/BOT.0000000000001670
[16] ZHANG F, ZHU L, LI Y C, et al. Retrograde versus antegrade intramedullary nailing for femoral fractures: a meta-analysis of randomized controlled trials[J]. Curr Med Res Opin, 2015, 31(10): 1897-1902. doi: 10.1185/03007995.2015.1078783
[17] EL MOUMNI M, VOOGD E H, TEN DUIS H J, et al. Long-term functional outcome following intramedullary nailing of femoral shaft fractures[J]. Injury, 2012, 43(7): 1154-1158. doi: 10.1016/j.injury.2012.03.011
[18] KIM J W, OH C W, OH J K, et al. Treatment of infra-isthmal femoral fracture with an intramedullary nail: is retrograde nailing a better option than antegrade nailing[J]. Arch Orthop Trauma Surg, 2018, 138(9): 1241-1247.
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