儿童及青少年股骨转子下骨折的治疗探讨

Strategy for treatment of subtrochanteric femur fractures in children and adolescents

目的探讨儿童及青少年股骨转子下骨折的治疗方法选择。方法62例年龄4～16岁的股骨转子下骨折患者，采用牵引加髋“人”字石膏（保守组）治疗14例，钛弹性钉或克氏针结合石膏（微创手术组）固定38例，钢板（传统手术组）固定10例。对本组患者的影像学结果、髋关节功能及并发症等资料进行回顾性研究。结果早期影像学结果Beaty评分：保守组满意5例，手术组满意44例；晚期影像学结果Theologis评分：保守组满意9例，手术组满意46例（P〈0．05）。髋关节功能Sanders评分：保守组优11例，良3例，手术组优43例，良5例（P〉0．05）。微创手术组与传统手术组并发症发生率及Sanders评分差异均有统计学意义（P〈0．05）。结论手术治疗比保守治疗能获得更满意的早期及晚期影像学结果。微创手术比传统手术具有更佳的疗效。针对患儿年龄、体重、骨折特点及软组织状况等选择合适的治疗方式是获得良好疗效的前提。

Objective To evaluate the treatment methods for subtrochanteric femur fractures in children and adolescents. Methods Sixty-two patients （at age of 4-16 years） with subtrochanteric femur fractures were managed with traction and delayed hip spica （14 patients, set as nonoperative group）, titanium elastic nails or pin combined with cast （38 patients, set as less invasive group） and plates （10 patients, set as traditional operative group）. The radiologic outcomes, hip joint function and complications of the patients were analyzed. Results According to Beaty scoring, five patients in nonoperative group and 44 in operative group obtained satisfactory early radiologic outcomes. Late radiologic outcome was satisfactory in nine patients from nonoperative group and 46 from operative group according to Theologis scoring, with statistical differences between two groups （P 〈 0. 05 ）. Sanders scoring showed excellent results in 11 patients and good in three from nonoperative group, and excellent results in 43 and good in five from operative group, with no statistical differences between two groups （ P 〉 0.05 ）. Less invasive group and traditional operative group showed significantly statistical different in aspects of complications and Sanders scores （P 〈 0. 05）. Conclusions Operative treatment provides more satisfactory early and late radiologic results than nonoperative methods. Less invasive operations have better outcomes than traditional operative methods. Selection of treatment modalities based on age, body weight, fracture features and soft tissue conditions of children is the prerequisite for a good outcome.