Treatment of an Open Femoral Shaft Fracture

開放性股骨幹骨折之治療

吳基銓(Chi-Chuan Wu) ； 施俊雄(Chun-Hsiung Shih) ； 翁文能(Wen-Neng Ueng)

《Journal of Orthopaedic Surgery Taiwan》 8卷2期 (1991/06) Pp. 85-95

摘要

閉鎖式擴腔式骨髓內釘是治療封閉性股骨幹骨折的優先選擇器材。但治療開放性股骨幹骨折卻是仍在爭議中。從1987年1月至1989年5月，共有89位開放性股骨幹骨折病人在本院治療且複查至少一年以上。清創術後之延遲性擴股術約在一星期時。癒合率88.8%，癒合期需5.8個月。膝關節活動平均為108度。7.0%發生傷口深部感染，原因為：與傷口之嚴重度或把外固定置換成內固定有關。不癒合有11.2%，也與傷口嚴重度有關。我們結論：對第一、二型骨折，應該選用閉鎖式擴腔式骨髓內釘治療，對第三A，三B型骨折，必須嚴格限用於徹底清創後；當有不乾淨懷疑時，應選用非擴腔式骨內釘或骨外固定架治療。第三C型則適用骨外固定奇。然而，從外固定轉換成擴腔式骨髓內釘具有危險性，如有釘孔感染懷疑時，轉換程序應視為禁忌。

並列摘要

A closed reamed intramedullary nail is th treatment of choice for a closed femoral shaft fracture. However, treatment of an open femoral shaft fracture is still controversial. From January 1987 to May 1989, 89 open femoral shaft fractures were treated at our hospital with a follow-up period of at least one year (average, 22 months), Delayed reaming after initial debridement was performed about one week’s interval. The union rate was 88.8% with a union period of 5.8±1.8 moths. Knee range of motion was on average 108 degrees. Deep infection, present in 7.0%, was correlated with wound severity and procedures of shifting external fixation to internal fixation. Nonunion was noted in 11.2% and also correlated with wound severity. We conclude that for type I, II open fractures, a closed reamed intramedullary nail should be chosen. For type IIIA, IIIB fractures, a closed reamed intramedullary nail can only be sued after thorough debridement. Whenever suspicion exists, a non-reamed intramedullary nail or an external fixation should be utilized. Type IIIC should be undoubtedly treated with external fixation. However, shifting procedure form external fixation to reamed intramedullary nailing is dangerous. If there is suspicious of pin tract infection, shifting is contraindicated.

並列關鍵字

femoral shaft ； open fracture ； reamed intramedullary nail