闭合复位与切开复位交锁髓内钉内固定术治疗股骨干骨折患儿的效果比较

Comparison of effects of closed reduction or open reduction combined with interlocking intramedullary nail internal fixation in treatment of femoral shaft fractures in children

目的:比较闭合复位与切开复位交锁髓内钉内固定术治疗股骨干骨折患儿的效果。方法:选取2019年4月至2023年2月该院收治的60例股骨干骨折患儿进行前瞻性研究,按照随机数字表法将其分为研究组与对照组各30例。对照组采用切开复位交锁髓内钉内固定术治疗,研究组采用闭合复位交锁髓内钉内固定术治疗,比较两组手术前后膝关节功能[Lysholm膝关节功能量表(LKS)]评分、膝关节屈膝度、应激反应指标[肾上腺素(E)、β-内啡肽(β-EP)、皮质醇(Cor)]水平,围术期指标水平,临床疗效和术后并发症发生率。结果:术后3个月,两组LKS评分和膝关节屈膝度均高于术前,且研究组高于对照组,差异有统计学意义(P<0.05);术后7 d,两组E、β-EP、Cor水平均低于术前,且研究组低于对照组,差异有统计学意义(P<0.05);研究组骨折愈合时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);研究组治疗优良率为90.00%(27/30),高于对照组的66.67%(20/30),差异有统计学意义(P<0.05);研究组并发症发生率为13.33%,低于对照组的36.67%,差异有统计学意义(P<0.05)。结论:闭合复位交锁髓内钉内固定术治疗股骨干骨折患儿可提高治疗优良率、LKS评分和膝关节屈膝度,降低应激反应指标、围术期指标水平和术后并发症发生率,其效果优于切开复位交锁髓内钉内固定术治疗。

Objective:To compare effects of closed reduction or open reduction combined with interlocking intramedullary nail internal fixation in treatment of femoral shaft fractures in children.Methods:A prospective study was conducted on 60 children with femoral shaft fractures admitted to the hospital from April 2019 to February 2023.They were divided into study group and control group according to the random number table method,30 cases in each group.The control group was treated with open reduction combined with interlocking intramedullary nail internal fixation,while the study group was treated with closed reduction combined with interlocking intramedullary nail internal fixation.The knee function[Lysholm knee scale(LKS)]score,the knee flexion,the stress response index[epinephrine(E),β-endorphin(β-EP),cortisol(Cor)]levels before and after the surgery,the perioperative index levels,the clinical efficacy,and the incidence of postoperative complications were compared between the two groups.Results:Three months after the surgery,the LKS score and the knee flexion of the two groups were higher than those before the surgery,those in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).Seven days after the surgery,the levels of E,β-EP and Cor in the two groups were lower than those before the surgery,those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).The fracture healing time and the hospitalization time of the study group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant(P<0.05).The excellent and good rate of treatment in the study group was 90.00%(27/30),which was higher than 66.67%(20/30)in the control group,and the difference was statistically significant(P<0.05).Further,the incidence of complications in the study group was 13.33%,which was lower than 36.67%in the control group,the difference was statistically significant(P<0.05).Conclusions:Closed reduction combine with interlocking intramedullary nail internal fixation in the treatment of the children with femoral shaft fractures can improve the excellent and good rate of treatment,the LKS scores and the knee flexion,and reduce the stress response index and perioperative index levels and the incidence of complications.Moreover,it is superior to open reduction combined with interlocking intramedullary nail internal fixation.