Pavlik挽具有限制动治疗新生儿股骨干骨折

Femur Shaft Fracture in Newborn Infants Treated by Using Pavlik Harness

目的探讨Pavlik挽具有限制动治疗新生儿股骨干骨折的临床疗效。方法 2005年1月-2010年1月,应用Pavlik挽具有限制动治疗新生儿股骨干骨折47例。其中男26例,女21例;左侧16例,右侧31例。臀产位13例,剖宫产29例,正常分娩5例。治疗时年龄12 h～23 d。骨折发生于股骨干中上1/3段38例,中1/3段骨折9例;斜形或螺旋形33例,横行骨折14例。大腿外观有明显向外成角及重叠缩短畸形。成角移位平均45°(22°～80°),短缩移位平均1.0 cm(0.5～2.0 cm)。患儿下肢足趾血运好,无其他合并伤。治疗采用Pavlik挽具,双膝屈曲、双侧髋屈曲外展有限制动。定期随访复查X线片及适时调整挽具。结果 Pavlik挽具应用最短3周,最长6周,平均4周。X线片示骨折线模糊,连续性骨痂形成后去除Pavlik挽具,并定期随访至学步期。平均随访20个月(8个月～4 a),47例骨折均一期治愈,患侧肢体外形好,无短缩,无跛行步态。结论 Pavlik挽具有限制动治疗新生儿股骨干骨折方便简捷、安全可靠、疗效好、并发症少,不需要住院或住院时间短。

Objective To explore the clinical effect of femur shaft fracture in newborn infants treated by Pavlik harness. Methods From Jan. 2005 to Jan. 2010,47 newborn infants with femur shaft fracture were treated by using Pavlik harness. Twenty - six male and 21 female were treated by pavlik hamess. Breach delivery in 29 cases,abdominal breach delivery in 13 cases. The left side involved 16 cases and right 31 cases. The average age of treatment 12 hours -23 days. Average angulation displacement was 45° （22° -80°） ,and average overriding displacement was 1.0 em （0.5 - 2.0 era）. All the fractures were in the mid - shaft or proximal third of the femur. Pavlik harness was applied to these patients and all of them were followed by X - ray evaluation weekly. There were no risk of avascular necrosis in these 47 cases. The Pavlik harness addresses the flexed, abducted, and externally rotated position of the proximal fragment. Reduction of the fracture is easily un- dertaken by adjusting the straps on the harness. Follow - up was performed including leg - length discrepancy, X - ray and so on. Results Treatment with Pavlik harness was used for 3 -6 weeks, and when good callous was evident on the radiographs,the harness was removed. All 47 fractures healed in satisfactory alignment, with full range of motion of the hips and knees after treatment. All patients were examined for leg - length discrepancy clinically by measuring the medial mallcolus. All patients undertook application of the Pavlik harness and the subsequent treatment without complications. The follow- up outcomes from 8 months to 4 years showed excellent contour, with no limp and overriding. Conclusions This treatment methods have advantages such as ease of application without general anesthesia, minimal hospitalization, possi- bility to adjust the harness without complications. It is satisfactory with correcting deformity of femur shaft fracture in a newborn infant.