| Objective:Analysis the treatment of adult femoral shaft fracture status in the class 3-A hospitals in Jiangxi Province,to investigate and compare the clinical effect and the difference between the two internal fixations of femoral shaft fractures, interlocking intramedullary nail (IIN) or plateing osteosynthesis(PO).Methods:Retrospective multi-center study, of the 387 patients with 404 femoral shaft fractures were collected from various research centers during January 2007-December 2009. Out of the 404 femoral shaft fractures,268 femoral shaft fractures were treated with the PO and 136 with the IIN.and the index measured includes operation time, surgical bleeding, fracture healing time and the complications (delayed nunion,postoperative inflection, intenal fixator loosening or fracture, malunion and so on) after operation between the two groups were compared.Results:The all cases were followed up for 1-3 years after operation. The average operation time in IIN group, was significantly longer than the treatment in PO group (p=0.000). The average amount of surgical bleeding was in IIN group was significantly greater than the PO group, respectively,459.774ml±108.791 ml and 429.961ml±113.783ml(p=0.013). The incident rate of nonunion or delayed union in IIN group was higher than in that of the PO group, respectively,10 cases and 9 cases. Mean healing time of the femoral fractures was 3.692±0.912 months in the IIN group and 3.535±0.884 months in the PO group. But as long as minimally invasive(closed reduction), using IIN for femoral shaft fractures can be early ambulation.11 patients treated with IIN ambulation(weight-bear) within 2 months, the patients with normal healing and don't found nails broking of and internal fixation loosening, and 4 cases in IIN group treated with closed reduction, no delayed union and nonunion of such complications. The failure rate of internal fixation in PO group (17 cases of plate broken of, screw loosening 5),was significantly higher than that of IIN group (p=0.007). Then the incidence of re-fracture in PO group was higher than that of IIN group, that 8 patients in PO group occurred re-fracture, but IIN group had 1 case occurred in femoral neck fracture. Conclusion:1. Low utilization rate with the IIN in Jiangxi province,which dose not match with international mainstream. Problely because IIN fixed technique for femoral fractures needs higher technical requirements, needs fracture table and corresponding image equipments, furthermore the medical workers'dedication and the ability to handle all sorts of temporary difficulties. But the PO technology is relatively simple and practical.2. In Jiangxi province, using IIN for femoral shaft fractures needs more time on operation, the injury is serious and the ambulation is slower after operation, it dose not match with the international mainstream. Requiring our medical workers to master the technology of IIN as soon as we can, we should not be forced to do anatomical reduction, do closed reduction for reducing damage and promoting early rehabilitation.3. There were very high complications for the treatment of femoral shaft fracture In Jiangxi province, includes in PO group or IIN group, which dose not match with international mainstream, It needs our medical workers to grasp the indications two treatments. If the condition does not suit for IIN, using PO must select the best type of steel plate, DCP(Dynamic compressive plate)for transverse or short oblique fractures, LP(locking plate)for comminuted fracture, which comply with the principle that is absolutely stability suit for simple fracture and relative stability suit for complex fracture.Due to the significant decrease in the failure rate of internal fixation with the IIN in comparison with the PO(Plate breakage,screw loosening) and the possible risk of refracture with PO, the authors recommend the IIN for the treatment of femoral shaft fractures. |
