The effect of antegrade femoral nailing on femoral head perfusion: a comparison of piriformis fossa and trochanteric entry points

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• 作者：Patrick C. Schottel ; Richard M. Hinds…
• 关键词：Piriformis fossa ; Greater trochanter ; Antegrade femoral nailing ; Medial femoral circumflex artery
• 刊名：Archives of Orthopaedic and Trauma Surgery
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：135
• 期：4
• 页码：473-480
• 全文大小：2,103 KB
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  18. Ansar
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-3916

文摘

Introduction Piriformis fossa entry antegrade femoral nailing is a common method for stabilizing diaphyseal femur fractures. However, clinically significant complications such as chronic hip pain, hip abductor weakness, heterotopic ossification and femoral head osteonecrosis have been reported. A recent cadaveric study found that piriformis entry nailing damaged either the deep branch of the medial femoral circumflex artery (MFCA) or its distal superior retinacular artery branches in 100?% of specimens and therefore recommended against its use. However, no study has quantitatively assessed the effect of different femoral entry points on femoral head perfusion. Materials and methods Twelve fresh-frozen cadaveric lower extremity specimens were randomly allocated to either piriformis fossa or trochanteric entry nailing using a 13-mm reamer. The contralateral hip served as an internal matched control. All specimens subsequently underwent gadolinium-enhanced fat-suppressed gradient-echo sequence MRI to assess femoral head perfusion. Gross dissection was also performed to assess MFCA integrity and distance to the opening reamer path. Results MRI quantification analysis revealed near full femoral head perfusion with no significant difference between the piriformis and trochanteric starting points (95 vs. 97?%, p?=?0.94). There was no observed damage to the deep MFCA in either group. The mean distance from the reamer path to the deep MFCA was 3.2?mm in the piriformis group compared to 18.5?mm in the trochanteric group (p?=?0.001). Additionally, there was a significantly greater number of mean terminal superior retinacular vessels damaged by the opening reamer in the piriformis cohort (1 vs. 0; p?=?0.007). Conclusions No statistically significant difference in femoral head perfusion was found between the two groups. Therefore, we cannot recommend against the use of piriformis entry femoral nails. However, we caution against multiple errant starting point attempts and recommend meticulous soft tissue protection during the procedure.