大龄儿童低位股骨粗隆下骨折钛弹性钉与钢板固定治疗的比较

Comparison of TEN and DCP for low subtrochanteric fracture in elder children

目的:比较钛弹性钉(TEN)与接骨板治疗大龄儿童低位股骨粗隆下骨折的放射学结果及临床疗效。方法:2009年12月至2011年9月,随机将33例低位股骨粗隆下骨折的大龄儿童患者分为两组,采用钛弹性钉治疗组(TEN组)18例,接骨钢板治疗组(DCP组)15例,比较两组患者手术时间、术中出血量、住院时间、骨折愈合时间、放射学结果、术后并发症及髋关节功能Sanders评分。结果:所有患儿术后随访12～18个月,平均15.8个月。无一例发生切口感染、内固定断裂、肢体短缩、骨骺早闭、髋关节僵硬、髋内翻、肢体旋转畸形、股骨头坏死等并发症。两组手术时间、出血量、住院时间及早期影像学评价差异有统计学意义(P<O.05),晚期影像学评价、骨折愈合时间、术后并发症和髋关节功能Sanders评分差异无统计学意义(P>0.05)。结论:对于大龄儿童低位股骨粗隆下骨折,TEN疗效优于接骨钢板,是一种安全、微创、并发症少的治疗方法。

Objective： To compare the radiographic and clinic results of treatment with TEN and blade plates for low subtrochanteric fracture in elder children. Methods： From December 2009 to September 2011, 33 elder children with low subtrochanteric fracture were treated by TEN （18 cases） and blade plates （15 cases） respectively. The operation time, blood loss, in-hospital time, union time, radiographic evaluation, postoperative complications and hip joint function according to Sanders scores were compared. Results： On average, the patients were followed up for 15.8 months （12 - 18 months）. There was no infection, implant breakage, limb shortening, premature arrest of epiphyses, stiffness or varus deformity of hip joint, and femoral head necrosis. There were statistical differences in operation time, blood loss, in-hospital time, and early radiographic evaluation between two groups （P 〈 0.05）, but no statistical difference in late radiographic evaluation, union time, postoperative complications and hip joint function according to Sanders scores （P 〉 0.05）. Conclusion： TEN is better than blade plates fixation as a treatment of low subtrochanteric fracture in elder children. It is secure, minimally invasive and rare complications technique.