股骨骨折复位器闭合复位弹性髓内钉内固定术在儿童股骨转子下骨折治疗中的应用

目的 探讨股骨骨折复位器闭合复位弹性髓内钉内固定术治疗儿童股骨转子下骨折的临床疗效。方法 回顾性分析2017年1月-2019年5月河北医科大学第三医院收治的7例儿童股骨转子下骨折患儿的临床资料。男5例,女2例;年龄4~9岁,平均6.2岁。左侧4例,右侧3例。SeinsheimerⅡA型1例,ⅡB型3例,ⅡC型1例,ⅢA型2例。7例患儿均应用股骨骨折复位器行闭合复位后,使用弹性髓内钉固定。观察闭合复位成功率,以及手术时间、术中出血、术后住院时间、骨折愈合时间;术后4 周根据Beaty 影像学标准评定早期疗效;末次随访时依据Flynn评分标准评价术后患肢功能。结果 本组7例患儿应用股骨骨折复位器闭合复位均获得满意效果,并顺利置入弹性髓内钉,骨折固定稳定。手术时间28~55 min,平均36 min;术中出血量5~15 mL,平均8 mL;住院时间3~5 d ,平均4 d。7例均获随访,随访时间6~28个月,平均22个月。所有骨折均骨性愈合,愈合时间6~10周,平均7.2周。术后4 周根据Beaty 影像学标准评定早期疗效:7例患儿均为满意。末次随访时按Flynn 评分标准评价患肢功能:优6 例,良1 例。结论 股骨骨折复位器闭合复位弹性髓内钉内固定术治疗儿童股骨转子下骨折,操作简便,闭合复位成功率和复位质量高,内固定稳定且可有效维持骨折对位,并可减少术者放射暴露时间。

Application of closed reduction with femoral fracture reductor and elastic intramedullary nail internal fixation in the treatment of subtrochanteric fracture in children

Objective To explore the clinical effect of closed reduction with femoral fracture reductor and elastic intramedullary nail internal fixation in the treatment of subtrochanteric femoral fracture in children. Methods The clinical data of seven children with subtrochanteric fracture who were admitted to the Third Hospital of Hebei Medical University from January 2017 to May 2019 were analyzed retrospectively. Among the children, five were males and two were females, and all aged between 4 and 9 years (mean of 6.2 years). Among the fractures, four were located on the left and three were on the right femur. In particular, one was in Seinheimer ⅡA, three were in ⅡB, another one was in ⅡC, and two were in ⅢA. After closed reduction with femoral fracture reductor was performed, all seven cases were fixed with elastic intramedullary nail. The success rate of closed reduction, the operation time, the intraoperative blood loss, the postoperative hospital stay, and the fracture healing time were observed. The early curative effect was evaluated in accordance with Beaty's standard imaging evaluation 4 weeks after the operation. The function of the affected limb was evaluated in accordance with the Flynn score during the last follow up. Results All cases achieved satisfactory reduction with the use of femoral fracture reductor, and the elastic intramedullary nail was successfully placed, and the fracture fixation was stable. The operation time was 28-55 min, with an average of 36 min. The intraoperative blood loss was 5-15 mL, with an average of 8 ml. The postoperative hospital stay was 3-5 d, with an average of 4 d. All patients were followed up for 6-28 months, with an average of 22 months. All fractures healed in 6-10 weeks, with an average of 7.2 weeks. The early curative effect was evaluated 4 weeks after the operation in accordance with Beaty's standard imaging evaluation, and the results showed that all children were satisfied. During the last follow up, the function of the affected limb was evaluated on the basis of the Flynn score, and the results were excellent in six cases and good in one case. Conclusions Using femoral fracture reductor for subtrochanteric fracture in children has the advantages of simple operation, high success rate of closed reduction, high-quality fracture reduction, effective maintenance of fracture alignment, and reduced radiation exposure time.