儿童股骨转子下骨折两种微创方法的对比研究

目的:探讨钛弹性钉治疗儿童股骨转子下骨折的可行性、临床疗效及其较克氏针固定的优势。方法:采用闭合复位钛弹性钉固定治疗30例年龄3～14岁的股骨转子下骨折患儿,并将其与同期进行、一般资料具有可比性,采用克氏针结合石膏固定治疗的22例患儿进行比较,对两组的手术指标、放射学结果及髋关节功能等进行分析。结果:弹性钉组平均随访时间43.6个月,克氏针组平均随访48.4个月,两组手术时间、出血量、骨折愈合时间等指标均无显著性差异。早期放射学结果按Beaty标准:弹性钉组结果满意占90.00%,克氏针组为86.36%;晚期放射学结果按Theologis标准:弹性钉组结果满意占93.33%,克氏针组为86.36%,上述差异均无统计学意义。髋关节功能Sanders评分:弹性钉组平均59.40分,克氏针组平均59.27分,差异无统计学意义。结论:通过适当的手术操作改良,弹性钉可以稳固固定大多数儿童转子下骨折,放射学结果及临床疗效满意,但并不比传统的克氏针结合石膏固定更有优势。

Comparison of two less invasive methods in treatment of subtrochanteric femur fractures in children

Objective：To evaluate the feasibility and results of titanium elastic nailing in treatment of subtrochanteric femur fractures in children and its advantages over pin combined with cast.Methods：30 children aged from 3 to 14 years with subtrochanteric fractures were managed with elastic nailing and compared with 22 data-matched children treated by pin and hip spica cast.The clinic data were reviewed.Results：The elastic nailing group with an average follow-up of 43.6 months yielded 90.00% satisfactory early radiologic outcomes（rated by Beaty criterion） and showed 93.33% satisfactory late radiologic outcomes（rated by Theologis criterion）.The pin group with an average follow-up of 48.4 months yielded same early and late radiologic satisfactory outcomes of 86.36%.The average score rated by Sanders criterion in the elastic nailing group was 59.40 while 59.27 in the pin group.There were no significant differences between the two groups.Conclusion：A majority of subtrochanteric fractures in children can be stabilized successfully using a modified surgical technique and satisfactory radiologic results as well as good functional outcomes achieved,but its has no obvious superiority over pin combined with cast