弹性髓内钉固定治疗儿童下肢长管状骨骨折

Treatment of pediatric femoral and tibial fractures with titanium elastic nails

目的探讨弹性髓内钉（titanium elasticnails，TENs）固定治疗儿童下肢长管状骨骨折的疗效。方法2004年6月-2010年10月在C形臂X线机监视下采用TENs治疗儿童下肢长管状骨骨折患者278例，其中男181例，女97例；年龄3～14岁，平均7．6岁。股骨骨折162例，其中35例采用切开复位内固定，其余均采用闭合复位。胫骨骨折116例，均采用闭合复位内固定，术后支具固定3—4周。平均住院7d。272例于术后半年内取出内固定，242例获得1年以上的随访，并继续观察肢体长度和患儿髋膝关节活动以及步态情况。结果所有患者随访6～66个月，平均33个月。骨折均愈合，无严重并发症发生。术后无一例出现感染、延迟愈合、骨折不愈合、TENs折断、骨骺损伤等并发症。有10例于术后3～4个月出现钉尾红肿而提前拔钉。19例出现双下肢〈1．0cm不等长，无明显跛行，下肢各关节功能无异常。根据Flynn评价标准，优良率达到100％。结论TENs固定治疗儿童下肢长管状骨骨折具有稳定性好、愈合快、切口小、复位满意、不破坏骨膜、利于骨折愈合、住院时间短、并发症少等特点，是治疗儿童下肢长管状骨的理想方法之一。

Objective To investigate the effect of intramedullary stabilization of lower limb fractures with titanium elastic nails （TENs） in children. Methods From June 2004 to October 2010,278 children were stabilized with TENs in our hospital, including 181 boys and 97 girls ＂at average age of 7.6 years （ range, 3.0-14 years）. There were 162 patients with femoral fractures, of which 35 underwent open reduction and the rest closed reduction. There were 116 patients with tibial fractures, which was treated with closed reduction. Postoperative fixation lasted for 3-4 weeks. The mean hospital stay was seven days. Of all the patients, 272 patients received the removal of the TENs six months after operation and 242 received more than one year of follow-up to have a further observation on the limb length, hip and knee mobility and gait condition in children. Results All the patients were followed up for 6-66 months （mean, 33 months）. All fractures were healed in good alignment without severe complications. There were no intraoperative complications like infections, delayed union, nonunion, TEN broken and femoral or tibial epiphysis injuries. Ten patients suffered from swell and skin irritation in the nail＇ s position 3-4 months after operation, and the nails were removed in advance. Nineteen patients showed unequal lengths （within 1 cm） of the lower limbs, with normal function of the lower limb joint but with no obvious limp. According to the Flynn evaluation standard, the excellent and good rate was 100%. Conclusions Characterized by good stability, rapid healing, small incision, anatomic reduction, unimpaired periosteurn, short hospital stay and few complications, intramedullary stabilization with titanium elastic nails can achieve effective fixation in the treatment of lower limb fractures in children.