弹性髓内钉治疗儿童股骨干骨折钢板固定失效病例

背景：弹性髓内钉固定通过三点支撑使骨折实现弹力固定，适用于儿童横形和短斜形四肢长管状骨折。文章针对儿童股骨干骨折钢板失效病例，探讨采用弹性钉技术治疗的优势所在。 目的：观察儿童股骨干骨折钢板固定失效后进行弹性髓内钉技术治疗的临床效果及预后分析。 方法：回顾性分析甘肃省中医院小儿骨科自2008年3月至2012年8月收治的21例儿童股骨干骨折行钢板固定后出现断裂及失效患者，术中均在原切口处取出断裂钢板，断端清理后，自股骨远端髌上1.0-2.0 cm处内外侧逆行经皮穿入弹性钉固定骨折。术后3-6个月根据影像学资料评估愈合情况取出弹性钉，按照 2001年Flynn骨折愈合评判标准进行疗效分析。 结果与结论：21例均获得随访，平均随访10个月。优19例，良2例，差0例，骨折愈合优良率100%。随访10个月，2例患侧肢体过度生长，不等长<1.0 cm，1年内下肢不等长消失，3例为膝关节活动受限 30°-50°，经功能练习1年后，2例膝关节活动受限<15°，1例膝关节活动受限>30°，无弹性钉断裂和骨不连现象发生。与切开复位治疗相比，弹性髓内针固定后骨折临床愈合恢复快，并发症少，是儿童股骨骨折内固定治疗的有效方法。

Elastic intramedullary nail for the treatment of femoral shaft fracture in children with failed plate fixation

BACKGROUND: Elastic intramedullary nail fixed technology supported by three principle of elastic fixation fracture is suitable for children’s short transverse and oblique shape limbs long tubular bone fracture. This paper will investigate the advantages of elastic intramedullary nail in the treatment of femoral shaft fracture with failed plate fixation in children. OBJECTIVE: To observe the clinical effect and prognosis of elastic intramedullary nail technology in the treatment of femoral shaft fracture with failed plate fixation in children. METHODS:Retrospective analysis was performed in 21 cases of femoral shaft fracture patients with plate fracture and failure after fixation in the Department of Pediatric Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine from March 2008 to August 2012. During the surgery, the plates were removed from the primary incision; after cleaned the fracture end, the medial and lateral retrograde percutaneous penetration of elastic nail was performed to fix the fracture on 1.0-2.0 cm from the femoral distal patellar. At 3-6 months after surgery, the healing of the fracture was evaluated based on the imaging data, and then the screw was removed. The efficacy was analyzed in accordance with the Flynn fracture healing criteria in 2001. RESULTS AND CONCLUSION: All the 21 patients were followed-up for 10 months in average. According to the Flynn fracture healing criteria, there were 19 cases of excellent, two cases of good, no poor, and the excellent and good rate was 100%. After followed-up for 10 months, two cases had overgrowth of affected limbs with the unequal length <1.0 cm, and disappeared in 1 year; three cases had limited activity of 30°-50°, and after 1 year functional exercise, two cases had limited activity of <15°, and one case had limited activity of >30°, there was no elastic nail breakage or nonunion. Compared with open reduction technology, elastic intramedullary nail for fracture fixation has fast recovery and healing and has fewer complications, so it is the effective method for the treatment of femoral shaft fracture fixation in children.