儿童股骨干骨折的微创弹性髓内针复位固定和切开复位LC-DCP钢板内固定治疗方法的临床比较

A clinical comparative study between minimally invasive flexible intramedullary nail fixation and open reduction and LC-DCP plate internal fixation on femoral shaft fracture in children

目的探讨儿童股骨干骨折的微创弹性髓内针复位固定及切开复位LC-DCP钢板内固定两种治疗术式的优劣性。方法 2007年4月—2010年5月期间昌黎县人民医院收治的6～13岁39例儿童股骨干骨折病例,其中微创通过弹性髓内针复位固定18例,切开复位LC-DCP钢板内固定21例。所选取的病例均为股骨干骨折,所有病例均未植骨。术后X线复查。37例均得到随访,随访时间为5～15个月,平均10个月,并应用HSS评分系统(主观评分系统)进行结果分析评价。结果 21例钢板手术后18周内骨折骨性愈合,骨折延迟愈合1例,过度生长1例;术后伤口全部一期愈合,无手术并发症出现;18例弹性髓内针,术后14周内骨性愈合,2例过度生长。结论对于儿童股骨干骨折采用微创弹性髓内针复位固定是一种微创内固定,效果可靠的治疗方法。效果与切开复位钢板内固定一样理想。但价格昂贵,并需要C型臂,不适于基层医院开展。术者可以根据具体情况选择合适患者的手术方法。

[ Objective ] To explore the advantages and disadvantages between minimally invasive flexible intramedullary nail fixation and open reduction and LC-DCP plate internal fixation on femoral shaft fracture in children. [ Methods] 39 children patients with femoral shaft fracture in Changli People＇s Hospital from April 2007 to May 2010 were collected, while 18 cases were treated with the minimally invasive flexible intramedullary nail fixation, and 21 cases were given the open reduction and LC-DCP plate internal fixation. All cases were femoral shaft fracture without bone grafting. X ray reexamination was conducted after surgery. All of 37 patients received the follow-up for 5-15 months （ average 10 months ）. The results were analyzed and evaluated by HSS scoring system. [ Results] All of 37 patients received the follow-up for 5-15 months （average 10 months ）. Among 21 cases undergoing plate internal fixation, fracture healing occurred within 18 months, there were 1 case of delayed union and 1 case of overgrowth, all postoperative wound were primary healing, and no operation complications were found. Among 18 cases undergoing intramedullary nail fixation surgery, fracture healing occurred within 14 months, there were 2 cases of overgrowth. [ Conclusion ] The minimally invasive flexible intramedullary nail fixation is a reliable method for treating femoral shaft fracture in children, and its effect is similar to open reduction and LC-DCP plate internal fixation. But this method is expensive and needs C ann, so it is not suitable for basic level hospital. The doctors can choose the appropriate surgical methods according to patient＇s condition.