Rotational malalignment after fractures of the femur.
Rotational malalignment after fractures of the femur.
复制标题
股骨骨折后旋转错位。
DOI：
10.1302/0301-620x.86b8.15663
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
A. V. Kampen
中科院分区：
文献类型：
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作者：
R. L. Jaarsma;A. V. Kampen
旋转对线不良是髓内钉治疗股骨干骨折的重要并发症。畸形是在手术过程中形成的，表明骨折复位不充分。对股骨旋转不良的发生率和临床意义知之甚少。在76名患者中，我们发现28%的患者存在旋转对线不良（15）。患者抱怨更多的要求活动的问题，如体育锻炼。旋转不良的发生率与使用的股骨髓内钉类型（GK或AO）或骨折位置无关。外旋畸形引起的症状明显多于内旋畸形。旋转对线不良通常通过临床或计算机断层扫描（CT）测量。CT是目前的首选方法。我们的研究表明，临床测量的准确性非常差（20）。此外，CT确定股骨旋转对线不良的准确性也值得怀疑。一个观察者的两次测量之间的差异可以是10.8，不同观察者的两次测量之间的差异可以是15.6。测量CT图像的不准确性主要由通过股骨颈绘制线的不准确性决定。所有股骨旋转不良的患者，相对于股骨扭转，倾向于向足部旋转的正常值补偿。这种补偿的主要部分发生在髋关节水平。与内旋不良患者相比，外旋不良患者的代偿困难更大。在体外，通过使用对侧小转子的轮廓作为参考，可以完全避免旋转对线不良。旋转仅测量到4（2.2 1.5）。美国医学会的永久性损伤评估指南在评估整个人的损伤时，股骨外部和内部旋转不良之间没有区别。这是不正确的，美国医学协会应该考虑在他们的指南中改变这一点。
Rotational malalignment is an important complication of intramedullary nailing for femoral shaft fractures. The deformity is established during the operation, indicating inadequate reduction of the fracture. Little was known about the incidence and clinical implications of femoral malrotation. In a series of 76 patients we found 28% to have rotational malalignment ( 15 ). Patients complain about problems with more demanding activities, like practicing sports. The incidence of malrotation was independent of the type of femoral nail (GK or AO) used or the location of the fracture. External rotational deformities cause significantly more symptoms than internal rotational deformities. Rotational malalignment is usually measured clinically or by computed tomography (CT). CT is currently the method of choice. Our study reveals that the accuracy of the clinical measurements is very poor ( 20 ). Also the accuracy of CT determined rotational malalignment of the femur is questionable. Differences between two measurements of one observer can be 10.8 and between two measurements of different observers 15.6 . The inaccuracy in measuring a CT image is mostly determined by the inaccuracy in drawing the line through the femoral neck. All patients with femoral malrotation tend to compensate towards a normal value of foot rotation, relative to the femoral torsion present. The major part of this compensation takes place at hip level. Patients with an external malrotation experience more difficulties compensating, than patients with an internal malrotation. In vitro, rotational malalignment is completely avoided by using the profile of the contralateral lesser trochanter as a reference. Rotations only up to 4 (2.2 1.5 ) were measured. The American Medical Association's Guide to the Evaluation of permanent Impairment does not differ between external and internal malrotation of the femur when evaluating whole person impairment. This is incorrect and the American Medical Association should consider changing this in their guidelines.