摘要
[目的]比较轴向牵引器辅助下顺行与逆行髓内钉固定股骨中下段骨折的临床疗效。[方法]回顾性分析2014年6月—2023年11月本院采用髓内钉固定股骨中下段骨折的72例患者资料。根据术前医患沟通结果,33例使用顺行髓内钉(顺行组),39例使用逆行髓内钉(逆行组)。比较两组围手术期、随访及影像资料。[结果]两组手术时间、切口长度、术中失血量、术中透视次数、下地行走时间、切口愈合等级、住院时间的差异均无统计学意义(P>0.05)。随访时间平均(54.7±27.2)个月,两组术后完全负重活动时间的差异无统计学意义(P>0.05)。与术后3个月相比,末次随访时两组疼痛VAS、KSS、Harris评分及膝伸-屈ROM均显著改善(P<0.05),相应时间点两组上述指标的差异均无统计学意义(P>0.05)。影像方面,术前及末次随访时,两组双侧股骨长度差、股骨远端外侧解剖角(anatomic lateral distal femoral angle,a LDFA)、股骨远端后侧角(posterior distal femoral angle,PDFA)、骨折对线的差异均无统计学意义(P>0.05)。术后3个月及末次随访时,顺行组骨折愈合mRUST评分显著不及逆行组[分,(10.9±2.0)vs(12.5±1.0),P<0.001;(14.4±1.9)vs(15.6±1.0),P<0.001]。[结论]与顺行髓内钉相比,逆行髓内钉可更好地控制股骨中下段骨折的远端稳定性,更有利于骨折愈合。
[Objective]To compare the clinical efficacy of antegrade intramedullary nailing versus retrograde nailing under assistance of axial distraction devices for the distal 1/3 shaft femur fractures.[Methods]A retrospective research was conducted on 72 patients who received intramedullary nailing for the femoral distal 1/3 shaft fractures in our hospital from June 2014 to November 2023.According to preoperative doctor-patient communication,33 patients underwent the antegrade nailing(the antegrade group),and the other 39 patients were treated with the retrograde nailing(the retrograde group).The perioperative,follow-up,and imaging data were compared between the two groups.[Results]There were no statistically significant differences between the two groups in terms of operation time,incision length,intraoperative blood loss,intraoperative fluoroscopy times,time to return ambulation,incision healing grade,and hospital stay(P>0.05).The average follow-up time was of(54.7±27.2)months,and there was no a statistically significant difference in the time to regain full weight-bearing activity between the two groups after surgery(P>0.05).Compared with those 3 months postoperatively,the pain VAS,KSS,Harris scores,and knee flexion-extension ROM in both groups were significantly improved at the last follow-up(P<0.05),and there were no statistically significant differences in the abovesaid indicators between the two groups at any corresponding time points(P>0.05).Radiographically,there were no statistically significant differences in the bilateral femoral length discrepancy,anatomic lateral distal femoral angle(aLDFA),posterior distal femoral angle(PDFA),and fracture alignment grade between the two groups before surgery and at the last follow-up(P>0.05).However,the antegrade group proved significantly inferior to the retrograde group in the modified radiographic union score for tibial(mRUST)[score,(10.9±2.0)vs(12.5±1.0),P<0.001;(14.4±1.9)vs(15.6±1.0),P<0.001]3 months postoperatively and at the latest follow-up.[Conclusion]Compared with the antegrade intramedullary nailing,the retrograde intramedullary nailing can better control the distal stability of femoral fractures,and is more conducive to fracture healing.
作者
耿泽月
周楠
齐瑞逢
杜刚强
孟险峰
常祺
王志刚
GENG Ze-yue;ZHOU Nan;QI Rui-feng;DU Gang-qiang;MENG Xian-feng;CHANG Qi;WANG Zhi-gang(Depart-ment of Traumatic Orthopedics,Affiliated Hospital,Binzhou Medical University,Binzhou 256603,Shandong,China;Department of Trau-matic Orthopedics,Central Hospital of Shengli Oilfield,Dongying 257034,Shandong,China;Institute of Military Training Medicine,The989th Hospital,PLA Joint Logistic Support Force,Luoyang 471031,Henan,China)
出处
《中国矫形外科杂志》
北大核心
2026年第3期221-227,共7页
Orthopedic Journal of China
基金
山东省医药卫生科技发展计划项目(编号:2017WS22,202004070551)
滨州医学院科研计划与科研启动基金项目(编号:BY2019KJ31)。
关键词
股骨中下段骨折
顺行髓内钉
逆行髓内钉
下肢轴向牵引器
内固定
distal one third shaft femur fractures
antegrade intramedullary nailing
retrograde intramedullary nailing
axial distraction device for lower limb
internal fixation
