儿童移位型股骨颈骨折16例临床分析

目的：回顾性评估切开复位、髋关节减压及内固定治疗16例移位股骨颈骨折患儿的中期临床效果。方法：2002年3月至2005年2月，应用减压、切开复位及内固定治疗了16例移位的股骨颈骨折患儿，其中男10例，女6例，平均年龄9．5岁（4～15岁）。按照Delbet分型原则，I型（股骨头骺滑脱）2例、II型（经颈型骨折）5例，III型（颈基底型骨折）9例；受伤机制包括：3例摩托车祸伤、8例高处坠落伤、2例滑雪伤，自行车摔伤、卡车车祸伤及滑冰伤各1例。方法为切开复位、髋关节囊小切口减压，直视下解剖复位，应用加压螺钉或克氏针内固定治疗。结果：16患儿均获得随访，平均随访时间3．6年。术后髋关节x线片评估复位效果：8例复位效果优，5例良，3例一般；14例应用加压螺钉固定，2例行克氏针固定。随访终了时的髋关节x线片提示1例患儿术后股骨头骺早闭，3例患儿合并股骨头坏死；13例患儿髋关节功能良好，日常生活无明显影响。结论：移位的股骨颈骨折患儿，小切口髋关节内减压、解剖复位及坚强内固定可减少股骨头坏死等相关并发症的发生，中期随访效果肯定。但Delbet分型I型骨折患儿术后头坏死发生率高，预后差。

Surgical Treatment of Fermoral Neck Fracture in Children

Objective： To retrospectively study the outcome of decompression and internal fixation for treating displaced femoral neck fracture in children. Methods： From March 2002 to February 2005, 16 children with displaced femoral neck fi＇actures were operated in our hospital. The study included 16 patients, 10 male and 6 female, with an average of 9.5 years （ranging from 4 to 15 years）, 2 cases of type I, 5 cases of type II and 9 cases of type III fractures as classified by the Delbet and Colonna system. Mechanisms of injury in- eluded motor vehicle accidents in 3 patients, fall from high in 8 patients, skiing injury in 2 patients, bicy- cling injury, ear accident and skating injury in 1 patient in each. All children were operated earlier after injury. Decompression of hip by miniarthrotomy to remove hematoma, open reduction and internal fixation were performed for all patients. Results： All patients were followed up for 3-7 years, immediate postoperative radiographs were closely analyzed to determine reduction accuracy. Results of reduction were excellent in 8 patients, good in 5 patients and fair in 3 patients. Follow-up radiographs showed that 13 patients obtained a good hip function, 1 patient had early epiphyseal plate closure and 3 patients had avascular necrosis according to Ficat criteria. Conclusion： Decompression of hip by miniarthrotomy and open reduction as well as internal fixation can get a good effect for displaced femoral neck fractures in children. It can reduce the complications such as avascular necrosis, but the incidence rate of avaseular necrosis is high and prognosis is poor in Delbet type I fracture.