股骨头干三维互动闭合复位治疗移位性儿童股骨颈骨折

目的 探讨应用股骨头干三维互动闭合复位技术治疗移位性儿童股骨颈骨折的临床疗效.方法 自2007年4月至2010年2月收治移位性儿童股骨颈骨折12例,其中男9例,女3例；年龄9～16岁,平均13岁；左侧7例,右侧5例.骨折按Delbet分型:经颈骨折11例、基底部骨折1例；按Garden分型:Ⅲ型2例,Ⅳ型10例,其中伴有股骨头旋转5例.所有骨折均采用股骨头干三维互动闭合复位技术复位,复位满意后应用2～3枚空心螺钉固定,并进行针吸减压.结果 11例(91.7％)骨折解剖复位,1例复位满意.手术时间40～55 min,平均47 min,出血量2～10 ml,平均3.8ml.所有患儿术后均获随访,时间14～48个月,平均23个月,骨折全部愈合,无一例发生股骨头缺血性坏死、骺板早闭及髋内翻等并发症.Harris髋关节评分为89～100分.结论 股骨头干三维互动闭合复位技术治疗移位性儿童股骨颈骨折具有创伤小,操作简单,容易掌握,复位效果理想等优点,值得临床推广.

Effect of minimally traumatic reduction technique on children with displaced femoral neck fracture

Objective To evaluate the therapeutic efficacy of minimally traumatic reduction technique on displaced femoral neck fractures of children.Methods From April 2007 to February 2010,12 cases of patients (M 9; F 3) suffering from displaced femoral neck fractures (left side:7; right side:5) were admitted to our centre for treatment.Their age ranged from 9 to 16 years old (average 13 years).According to Delbet classification,11 cases were transcervical types and 1 was basicervical type.Meanwhile,referring to Garden classification,2 cases were type Ⅲ and 10 were type Ⅳ,among which femoral head rotated in 5 cases.The displaced procedure was performed by using a minimally traumatic reduction technique.After reduction the fracture was fixed with two or three cannulated screws and needle aspiration was conducted to further decrease intracapsular pressure.Results In terms of the curative efficacy,11 of all patients (91.7％) achieved an anatomical reduction,while 1 case achieved an acceptable reduction.The mean operation time was 47 min (ranging from 40 to 55 min) and average blood loss during surgery was 3.8 ml (2-10 ml).All cases were followed up for 23 months averagely (14-48 M).All fractures in patients healed without AVN,coxa vara deformity or premature physeal closure The Harris scoring for them ranged from 89 to 100.Conclusions The children with displaced femoral neck fractures can achieve better anatomic reduction using the minimally traumatic reduction technique,which is an easy technique to perform with less injury and complication for children.