- 期刊
- OpenAccess
Clinical Results of the Expandable Intramedullary Nail System in Diaphyseal Fractures of Femur and Tibia
以擴張式髓內釘治療股骨幹及脛骨幹骨折的臨床成果
摘要
The locked Intramedullary nail is the principal technique used to fix diaphyseal fracture of long bones. However, the secondary healing process is slow because weight bearing is not directed onto the fracture site. Altered methods include second stage dynamization or usage of large-diameter nail without reaming the canal. The expandable nail (Fixion nail) is a new option that resolute some problems in previous techniques and provide early weight bearing and improvement of union rate. We analyzed 152 fractures of femur and tibia treated by Fixion nail or interlocking nail and provided clinical result. This was a retrospective nonrandomized study encompassing 86 femoral fractures and 66 tibial fractures in 149 patients treated by interlocking nail and Fixion nail. They were classified into three groups according to the AO classification of fracture pattern. Patients were followed for at least one year. Clinical and radiological evaluations were done at one, three, six, 9 and 12 months after the surgery. Radiographic bone union is defined as at least three cortical connection in both anterior-posterior and lateral views. The total success rate of bone union in one year is 93.4%. The union time and nonunion rate of expandable nail fixation are compared with those of interlocking nail fixation in different fracture groups No major complication such as sudden death or pulmonary embolism happened in these patients. Non-union happened in ten fractures including five treated by interlocking nail and another five treated by Fixion nail after one year. No significant differences in baseline characteristics including age, gender, types of bone fractures, and sites of bone fracture between two groups. There was no significant difference in the overall incidence of bone union at the end of follow-up. Overall, patients treated with Fixion nail had significantly shorter time to bone union than those treated with interlocking nail. Patients with simple fracture had shorter time to bone union in Fixion nail group than interlocking nail group. The expandable intramedullary nail presents significant advantages in the treatment of transverse fractures of femur and tibia compared with interlocking nail. The union time of simple fracture treated by Fixion nail is faster than that is treated by interlocking nail in first six months, but the phenomenon is not predominant after one year. Expanding nail is not suitable for communicated fracture because it can’t provide initial absolute stability and fail in first stage bone healing more easily. Therefore, appropriate selection of fixation device according to fracture pattern is still the best way to achieve successful clinic outcome.
並列摘要
鎖定式髓內釘是治療長骨幹骨折的標準手術方法。但因為減少了骨折部位的負重刺激，導致第二階段骨癒合過程變慢。改變的方法包括第二階段授動術或使用大直徑內定合併非磨鑽技術。可擴張式髓內釘（菲克迅釘）是一個新的選擇，可以解決以前傳統手術技術中的一些問題，並可以提供早期負重和提高癒合率。我們分析了152例經菲克迅釘或鎖定式髓內釘治療的股骨與脛骨骨折，並提供臨床效果。這是一項回顧性的非隨機研究，共有149名患者分別使用鎖定式髓內釘和菲克迅釘治療，包括86例股骨骨折和66例脛骨骨折。病人根據AO骨折分類將其分為三組，術後追蹤至少一年。在手術後第一、三、六、九和十二個月分別進行臨床和放射學評估，以檢查臨床成果和放射影像學上骨癒合情形。骨癒合定義為X光影像前後及側位照相中，出現至少三面皮質骨癒合。一年內骨癒合成功率為93.4%。使用可擴張式髓內釘和鎖定式髓內釘的骨癒合時間與不癒合率，將分別在不同骨折型態的群組作比較分析。這些患者沒有發生猝死或肺栓塞等主要併發症。十位病患發生骨不癒合，包括五例的股骨骨折與五例的脛骨骨折。兩組患者的年齡，性別，骨折類型，骨折部位等基本特徵並無顯著差異。在一年的追蹤結束時，每個群組的骨癒合率沒有明顯統計上的差異。整體而言，使用菲克迅釘的病患達到骨癒合的時間，比使用鎖定式髓內釘的病患較為減短。在同樣為單純骨折型態的病人中，使用菲克迅釘治療，更顯著的減少達到骨癒合的時間。在橫斷型的股骨或脛骨骨折中，使用可擴張式髓內釘治療會比鎖定式髓內釘更具有優勢。在單純型骨折的病患前六個月的追蹤中，接受菲克迅釘治療的癒合速度更明顯比鎖定式髓內釘減少，但這個現象病患在追蹤一年後反而較不明顯。可擴張式髓內釘不適合使用在粉碎型骨折的治療，因為它無法提供早期的絕對穩定性，更容易造成第一階段的骨癒合失敗。因此，根據骨折類型適當選擇固定裝置，仍是實現治療成功的最佳途徑。