弹性髓内钉治疗儿童双侧股骨干骨折

Application of elastic intramedullary nail in treating bilateral femoral shaft fractures in children

目的:探讨弹性髓内钉闭合复位内固定治疗儿童双侧股骨干骨折的疗效及并发症。方法:自2005年2月至2008年3月采用弹性髓内钉闭合复位治疗儿童双侧股骨干骨折7例,男5例,女2例,年龄3～13岁,平均8.3岁。车祸伤6例,高处坠落伤1例。合并伤:肺挫伤2例,颅脑损伤3例,膀胱损伤1例,跟骨骨折1例,无神经血管损伤及骨筋膜室综合征,均为闭合性骨折。2例患者术后采用石膏辅助外固定。结果:7例患者均获得随访,时间21～37个月,平均30.3个月,无一例发生切口感染,无继发骨折移位及内固定物失效或断裂。7例患者14侧骨折全部愈合,骨愈合时间7～12周,平均8.7周。无延迟愈合,骨不连,旋转畸形,髋、膝关节的功能障碍。1例患者出现双下肢不等长(长度差5 mm)。根据Flynn提出的评分标准,结果均为优。结论:采用弹性髓内钉治疗儿童股骨干骨折符合生物学固定原则,创伤小,并发症少,是治疗儿童高能量损伤股骨骨折的较好选择。

Objective：To explore the curative effects and complications of elastic intramedullary nail in treating children＇s bilateral femoral shaft fractures.Methods：Form February 2005 to March 2008,7 patients with bilateral femoral shaft fractures were treated by closed reduction and internal fixation with elastic intramedullary nail.There were 5 males and 2 females.The age ranged from 3 to 13 years with the mean of 8.3 years.Six injuries caused by road accident and 1 injury caused by fall from high.Two cases associated with pulmonary contusion,3 cases brain injuries,1 case fracture of calcaneus and 1 case bladder injuries.All the cases were closed fractures without nerve and blood vessel injury.A cast external fixation had been used after operation for a month in two cases.Results：All the patients were followed up for 21-37 months with an average of 30.3 months.No infecton of incisional wound,displacement fracture,internal fixation fail,delayedunion and malunion were found.All fracture obtained healing for 7-12 weeks with an average of 8.7 weeks.Inequality of lower limb was found in 1 case（length differences was 5 mm）.According to Flynn scoring,all fractures were excellent.Conclusion：Treatment of femoral shaft fractures in children with elastic intramedullary nail according with biological principle.The method has little trauma,less compilication,outstanding effect and it is a good way to treat bilateral femoral shaft fractures result from high energy injuries.