弹性髓内钉治疗大龄儿童股骨粗隆下骨折的临床疗效分析

The efficacy of elastic intramedullary nailing for femoral subtrochanteric fractures in older children

目的比较弹性髓内钉（TEN）和石膏外固定治疗儿童股骨粗隆下骨折的临床疗效。方法回顾分析30例儿童股骨粗隆下骨折的病例资料，其中14例行弹性髓内钉固定治疗（弹性髓内钉组），16例采用手法复位髋石膏固定（石膏固定组）治疗，记录骨折愈合时间及并发症，术后对两组患儿的影像学结果、髋关节功能进行比较分析。结果所有患儿术后随访20～43个月．平均31个月。骨折均获愈合，愈合时间8～17周，平均10．5周。TEN组未发生切口感染、内固定物失效或断裂，有1例患儿术后复查有轻度矢状面成角，无髋内翻、肢体短缩等畸形。所有患儿随访中均未发现有骨骺损伤早闭，股骨头缺血性坏死。石膏固定组术后复查有5例患儿出现轻度矢状面成角畸形，髋内翻畸形3例，肢体缩短6例。早期结果按Beaty标准：TEN组满意率为92．9％，明显优于石膏同定组62．5％（P〈0．01）；晚期结果按Theologis标准：TEN组满意率为100％，石膏固定组81．3％，两组亦存在显著性差异（P〈0．01）。髋关节功能按Sanders标准：TEN组优12例，良1例，优良率：92．9％；石膏固定组优9例，良4例，优良率：8I．4％，组间差异有统计学意义（P〈（1．05）。结论TEN固定治疗儿童股骨粗隆下骨折的临床疗效优于石膏固定法，它具有创伤小、操作简便、固定更为牢固、并发症少等优点，值得临床推广应用。

Objective To compare the result of treatment with titanic elastic nail （TEN） and plaster fixation for subtrochanterie fractures in skeletally immature adolescents. Methods A retrospec- tive review of 30 subtrochanteric fractures was carried out. In this series, 14 patients were treated with TEN fixation and 16 had plaster immobilization. Early and late radiographic evaluation, joint function assessment were carried out. Results On average, the patients were followed up for 31 months （20-43 months）. Bone union was accomplished in all patients. The mean time to union was 10. 5 weeks, ranging from 8-17 weeks. One patient treated with TEN developed AP angulation. No other complication were detected in the TEN group. In the plaster immobilization group, there were 5 AP angulation, 3 coxa vara and 6 limb shortening. According to the Beaty＇s grading, early percentage of good results is 92. 9% in TEN group and 62. 5~ in the palster group （P^0. 01 ） ; for late results according to the Theologis＇ s standerd, TEN group＇s good rate is 100~ and the plaster group is 81.3~0（P^0. 01）. The joint function in 12 patients were good, 1 fair according to the Sanders＇s standard in the TEN group , The total percentage of good and fair is 92. 9%. The joint function in the plaster group was goo in 9 patients, fair in 4 patients. Together, these accounted for 91.4% of all cases（P0. 05）. Conclusions TEN is better than piaster fixation as a treatment of Subtrochanteric fractures in skeletally immature asolescents.