闭合及切开复位内固定治疗学龄儿童股骨粗隆下骨折的对比分析

目的比较弹性髓内钉内固定闭合或切开复位治疗学龄儿童股骨粗隆下骨折的疗效。方法选取我院2013年1月至2017年12月采用弹性髓内钉治疗股骨粗隆下骨折的学龄儿童19例。受伤至手术时间2~8天,平均4天。按照手术方法分为闭合复位内固定组(A组):共10例,其中男7例,女3例;年龄6~10岁,平均7.2岁。致伤原因分为交通事故伤6例,高处坠落伤3例,其它伤1例。骨折按Seinsheimer分型分为ⅡA型3例,ⅡB型2例,ⅡC型2例,ⅢB型2例,Ⅳ型1例。切开复位内固定组(B组):共9例,其中男6例,女3例;年龄7~12岁,平均7.8岁。交通事故伤5例,高处坠落伤3例,其它伤1例。骨折按Seinsheimer分型分为ⅡA型3例,ⅡB型2例,ⅡC型1例,ⅢB型2例,Ⅳ型1例。B组中归入4例先行闭合复位不满意后再切开复位患儿。本组术后均辅以髋人字石膏固定。所有患儿均获满意随访,平均随访时间14.9(12~36)个月。比较两组患儿的一般资料、手术时间、术中出血量、骨折愈合时间和并发症的发生情况。结果两组患儿的性别、年龄、体重、受伤至手术时间相比,差异均无统计学意义(P>0.05),不具有可比性。A组术中出血量(12.6±4.2)ml少于B组(55.4±10.5)ml,A组手术时间(98±12)min长于B组(75±10)min,两组相比差异均有统计学意义(P<0.05)。骨折愈合时间两组相比差异无统计学意义(P>0.05)。两组均无切口感染以及其它严重并发症发生。依据Flynn等提出的评分标准评定髋关节功能,A组优8例,良2例,B组优8例,良1例,所有患儿髋膝关节活动良好,两组比较差异无统计学意义(P>0.05)。结论弹性髓内钉治疗学龄儿童股骨粗隆下骨折是一种安全有效的方法,术中闭合复位或切开复位均可获得满意疗效。

Efficacy analysis of open and closed reduction using elastic stable intramedullary nailing for subtrochanteric fracture in school-age children

Objective To compare the effects between open reduction and closed reduction with elastic stable intramedullary nail(ESIN)in the treatment of subtrochanteric fracture in school-age children.Methods Nineteen school-age children(13 males and 6 females)with subtrochanteric fractures were treated with ESIN from January 2013 to December 2017.According to different surgical methods,all patients were divided into closed reduction and internal fixation group(Group A,n=10)and open reduction and internal fixation group(Group B,n=9).Group A:7 males and 3 females;aged 6-10 years(mean:7.2 years);traffic accident injury in 6 cases,falling injury in 3 cases,other injuries in 1 case;3 typeⅡA cases,2 typeⅡB cases,2 typeⅡC cases,2 typeⅢB cases,1 typeⅣcase according to Seinsheimer classification;Zig-zag plaster immobilization was conducted.Group B:6 males and 3 females;aged 7-12 years(mean:7.8 years);traffic accident injury in 5 cases,falling injury in 3 cases,other injuries in 1 case;3 typeⅡA cases,2 typeⅡB cases,1 typeⅡC cases,2 typeⅢB cases,1 typeⅣcase according to Seinsheimer classification;4 cases after unsatisfactory closed reduction were included;Zig-zag plaster immobilization was conducted.The average time from injury to operation was 4 days(range:2-8 days).All patients were followed up with an average of 14.9 months(range:12-36 months).General data,operation time,intraoperative blood loss,fracture healing time and complications were compared between the two groups.Results There were no statistically significant differences in sex,age,body weight,fracture healing time,and time from injury to operation between the two groups(P>0.05).The intraoperative blood loss in Group A(12.6±4.2)ml was less than that in Group B(55.4±10.5)ml with statistical significance(P<0.05).The operation time in Group A(98±12)min was longer than that in Group B(75±10)min with statistical significance(P<0.05).There were no incision infection or other serious complications in both groups.Hip functions assessed by Flynn standard:8 excellent cases and 2 good cases in Group A;8 excellent cases and 1 good case in Group B;good knee functions with no significant differences between the two groups(P>0.05).Conclusions Elastic intramedullary nailing is safe and effective in the treatment of subtrochanteric fracture of the femur in school-age children.