髋关节前侧短切口治疗儿童Delbet Ⅱ型股骨颈骨折

A mini-incision on the anterior hip for pediatric femur neck fractures of type Delbet Ⅱ

目的探讨髋关节前侧短切口切开复位内固定术治疗儿童Delbet Ⅱ型股骨颈骨折的临床效果及手术经验。方法回顾性分析2014年1月至2016年8月于南京医科大学附属儿童医院骨科采用髋关节前侧短切口切开复位内固定术治疗的12例Delbet Ⅱ型股骨颈骨折患儿资料,男性7例,女性5例,年龄(11.5±0.8)岁(范围:8~14岁)。左侧8例,右侧4例,受伤至手术时间(12.0±0.9)h(范围:6~20 h)。手术切口以髂前下棘为中点,向两端沿腹股沟方向延伸,长3~4 cm;于缝匠肌与阔筋膜张肌间隙进入,拉开股直肌,暴露关节囊前方,T形切开关节囊暴露骨折并复位,使用2~3枚空心加压螺钉固定。术后定期行X线检查及临床检查判断骨折愈合时间,记录相关并发症。末次随访时根据Ratliff评分标准评价手术效果。结果12例患儿均获得随访,随访时间(30.0±4.1)个月(范围:24~36个月)。患者X线片均显示骨折愈合,愈合时间为(8.0±0.4)周(范围:7~9周)。其中2例患儿发生Ratliff Ⅱ型股骨头缺血性坏死,1例患儿发生骺早闭,无骨折再移位、髋内翻、延迟愈合、骨不连等,无切口感染、螺钉松动、断裂等并发症发生。Ratliff评分:良9例(9/12)、可3例(3/12)、差0例。结论髋关节前侧短切口入路切开复位内固定治疗儿童Delbet Ⅱ型股骨颈骨折,近期临床效果满意,具有创伤小、美观、复位固定可靠、切口并发症少等优势。

ObjectiveTo investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture.MethodsA retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children′s Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11.5±0.8) years (range: 8-14 years).Patients underwent surgery in (12.0±0.9) hours (range: 6-20 hours) after the injury. Displaced fractures were treated by open reduction if closed reduction failed.The surgical incision was performed with the anterior inferior iliac spine centered on, extending along the groin crease, and the length was 3 to 4 cm. The interval between the sartorius and the tensor fascia latae was applied, and the direct and indirect head of rectus femoris were resected to visualize the hip joint capsule. T-shaped incision was made in the capsule. After the reduction was obtained, two or three compression canulated screws were used to fix the fracture site. The healing time, complications and corresponding record outcome by X-ray and clinical examination were recorded. At the latest follow-up,the results were analyzed using the Ratliff criteria and clinical outcomes were assessed by pain, restrictive hip movement, normal activity or the avoidance of games, and the femoral neck in the radiograph.ResultsTwelve patients had been followed-up for (30.0±4.1)months(range: 24-36 months). X-ray showed the fractures′ healing time was (8.0±0.4) weeks(range: 7-9 weeks). Ten of the 12 fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. One case occurred premature physeal closure. There were no cases with fracture relocation, coaxvara, delayed union and nonunion or any significant postoperative complications. There was no infection, flexible internal fixation or ruptures. According to Ratliff grade, 9 cases of 12 patients were fine and 3 cases was acceptable.ConclusionsSatisfactory short-term effects can be achieved by a mini-incision on the anterior hip for Delbet Ⅱ pediatric femur neck fractures. The anterior incision has the advantage of less trauma, smaller incision scar, better fracture reduction and fixation, and less wound complications.