移位儿童股骨颈骨折的手术治疗——3年随访报告

目的 回顾性评估切开复位、髋关节减压及内固定治疗移位股骨颈骨折患儿的中期临床效果.方法 2002年3月至2005年2月,应用减压、切开复位及内固定治疗了16例移位的股骨颈骨折患儿,其中男10例, 女6例,平均年龄9.5岁(4～15岁).按照Delbet分型原则, Ⅰ型(股骨头骺滑脱)2例、Ⅱ型(经颈型骨折)5例, Ⅲ型(颈基底型骨折)9例;受伤机制包括:3例摩托车祸伤、8例高处坠落伤、2例滑雪伤,自行车摔伤、卡车车祸伤及滑冰伤各1例.方法 为切开复位、髋关节囊小切口减压,直视下解剖复位,应用加压螺钉或克氏针内固定治疗.结果 16患儿均获得随访,平均随访时间3.6年.术后髋关节X线片评估复位效果:优8例、良5例、一般3例;14例应用加压螺钉固定,2例行克氏针固定.随访终了时的髋关节X线片提示1例患儿术后股骨头骺早闭,3例患儿合并股骨头坏死;13例患儿髋关节功能良好,日常生活无明显影响.结论 移位的股骨颈骨折患儿,早期的小切口髋关节内减压、解剖复位及坚强内固定可减少股骨头坏死等相关并发症的发生,中期随访效果肯定.

Surgical treatment of displaced femoral neck fracture in children-a report of 16 cases of three years' fellow-up

Objective To evaluate the outcome of decompression and operative fixation for displaced femoral neck fractures in children. Methods From March 2002 to February 2005, sixteen children including 6 females and 10 males with displaced femoral neck fractures underwent operation in our hospital. The average ages at injury were 9.5 years (4 -15 years). The group involved 2 type I fracture, 5 type II and 9 type III fractures, as classified by the Delbet and Colonna system. Mechanisms of injuries were: 3 patients were injured by motorcycle, 8 fell from high places, 2 were injured in snow skiing, and the other 3 suffered injuries due to riding bicycle, car accident and skating respectively. All children underwent early post-injury operation. They were performed with miniarthrotomy, open reduction and internal fixations.Results All patients were followed up for 3 to 7 years after injury, with an average length of 3.6 years. Immediate postoperative radiographs were taken to determine the reduction accuracy. Eight patients had excellent reductions, 5 were good, and 3 were fair. Internal fixations were performed on fourteen patients with compressive screws and 2 patients with K-wires. Follow-up radiographs revealed epiphyseal plate closure in 1 patient, avascular necrosis of the femoral head in 3 patients. Thirteen patients had good hip functions without motion limitation. ConclusionsEarly post-injury decompression of hip by miniarthrotomy and open reduction with internal fixations get good clinical outcomes for displaced femoral neck fractures in children. It decreases the morbidity of post-injury avascular necrosis of the femoral head.