弹性髓内钉治疗学龄期儿童胫骨干长螺旋形骨折的疗效分析

Efficacy of elastic stable intramedullary nailing for school-age children with long spiral tibial shaft fractures

目的探讨弹性髓内钉(elastic stable intramedullary nailing,ESIN)治疗学龄期儿童胫骨干长螺旋形骨折的临床疗效。方法回顾性分析2014年10月至2019年10月大连市妇女儿童医疗中心(集团)小儿骨科采用弹性髓内钉治疗的113例学龄期儿童胫骨干骨折病例资料。根据骨折类型分为长螺旋形骨折组(37例37侧)、横形/短斜形骨折组(76例76侧)。比较两组患儿基本资料、手术情况、住院时间、治疗效果以及术后并发症情况。结果两组患儿年龄、性别、骨折位置及左/右侧别、是否伴有腓骨骨折、手术时间、术中出血量、完全负重时间、髓内钉取出时间、总住院时间及治疗费用比较,差异均无统计学意义(P>0.05)。根据Flynn评分标准评估临床疗效,两组疗效差异也无统计学意义(P>0.05)。长螺旋形骨折组有1例(1侧)发生并发症(1/37,2.70%),横形/短斜形骨折组共有3例(3侧)发生并发症(3/76,3.94%),但差异无统计学意义(P>0.05)。结论弹性髓内钉治疗学龄期儿童胫骨干长螺旋形骨折疗效确切,术后并发症的发生率较横形/短斜形骨折无明显增加。

Objective To explore the clinical efficacy of elastic stable intramedullary nailing(ESIN)for long spiral tibial shaft fractures in school-age children.Methods From October 2014 to October 2019,retrospective analysis of tibial shaft fractures was conducted for 7-12-year-old school-age children using elastic intramedullary nails.According to fracture type,they were divided into two groups of long spiral fracture(n=37)and horizontal/short oblique fracture(n=76).Basic profiles,intraoperative findings,hospitalization length,treatment outcomes and postoperative complications of two groups were compared.Results No significant inter-group differences existed in gender,age,sideness,injury cause,fracture site,fibula fracture or not,operative duration,intraoperative blood loss,hospitalization length or medical expenditure(P>0.05).No significant inter-group difference existed in Flynn efficacy evaluation of ESIN(P>0.05).There was no significant inter-group difference in fracture healing time,complete weight bearing time or intramedullary nail removal time(P>0.05).Complication rate was 2.70%in long spiral fracture group and 3.94%in transverse/short oblique fracture group.There was no statistically significant inter-group difference(P>0.05).Conclusion ESIN has an excellent therapeutic efficacy for school-age children with long spiral tibial shaft fractures.With minimal invasiveness,there is a low risk of postoperative complications.It is worthy of widespread clinical applications.