弹性髓内钉固定与外固定支架治疗儿童股骨干骨折疗效比较

目的：比较弹性髓内针与外固定支架治疗儿童股骨干骨折的疗效。方法：2002年9月至2008年8月治疗儿童股骨干骨折共67例,使用弹性髓内针治疗儿童股骨干骨折36例,男23例,女13例,年龄5～11岁,平均（7.1±1.6）岁;外固定支架治疗31例,男19例,女12例,年龄3～12岁,平均（6.5±2.3）岁。所有病例均为闭合复位,对两种不同内固定术后骨折愈合时间、术后并发症进行比较分析。结果：全部病例均获随访,时间9～24个月,平均（12±3）个月。弹性随内针组治疗小儿股骨骨折在骨折临床愈合时间和骨性愈合时间均短于外固定支架组（P〈0.05）。外固定支架组,继发钉道感染5例,骨折延迟愈合3例,再骨折2例,螺钉断裂1例;弹性髓内针组钉尾激惹3例。结论：弹性髓内针治疗儿童股骨干骨折有很大优势,而对高能量骨折及多发伤的病例外固定支架则不失为一种良好的选择,股骨近端和远端骨折尽量避免使用弹性髓内针固定。

Clinical outcomes of elastic intramedullary nail fixation and external fixation for the treatment of pediatric femoral shaft fractures

Objective: To compare clinical outcomes of elastic intramedullary nail fixation and external fixator for the treatment of pediatric femoral shaft fractures. Methods: From Sep. 2002 to Aug. 2008,67 pediatric patients with femoral shaft fractures were treated. Among them,36 pediatric patients with femoral shaft fractures were treated with closed reduction and elastic intramedullary nail fixation including 23 males and 13 females with an average age of(7.1±1.6) years ranging from 5 to 11 years; while 31 patients were treated with closed reduction and external fixation including 19 males and 12 females with an average age of(6.5±2.3) years ranging from 3 to 12 years. All patients obtained closed reduction. The fracture healing time and postoperative complications were compared between these two groups. Results: All patients were followed up for 9 to 24 months,in averaged(12±3) months. The time of fracture healing and bone union in elasitic intramedullary nail group was shorter than that of external fixation group(P<0.05). There were 5 cases of infection,3 of delayed healing,2 of refracture,and 1 of fixation failure in external fixation group,and there were 3 of soft tissue irritation in elastic intramedullary nail group. Conclusion: Elastic intramedullary nail has some advantages for the treatment of pediatric femoral shaft fracture,while external fixation has some advantage in patients with multiple injury and open injury. The proximal and distal femoral fractures are not suitable for elastic intramedullary nail fixation.