弹性髓内钉与接骨板治疗儿童股骨中上段骨折疗效比较

Titanium elastic nail versus plate-screw fixation for the treatment of upper segment fractures of femoral shaft in children

目的：比较弹性髓内钉与接骨板治疗儿童股骨中上段骨折的临床疗效.方法：自2006年1月至2012年8月对32例儿童股骨中上段骨折的患者随机抽签接受弹性髓内钉与接骨板治疗.弹性髓内钉治疗组19例,男11例,女8例;年龄3～11岁,平均（6.9±2.2）岁;AO分型：A型11例,B型6例,C型2例.接骨板组13例,男9例,女4例;年龄5～12岁,平均（7.5±2.1）岁;AO分型：A型3例,B型6例,C型4例.对两组患者的手术时间、术中出血量、手术切口长度、住院时间、骨折愈合时间、术后并发症、功能疗效等进行比较分析.结果：弹性髓内钉组平均随访时间25.3个月（15～48个月）,接骨板组平均随访时间21.6个月（13～36个月）.手术时间、住院时间、内固定取出时间、骨折愈合时间在弹性髓内钉组分别为（56.7±11.2） min、（6.6±3.9）d、（8.1±2.3）个月、（12.6±3.8）周,接骨板组分别为（51.5±8.3） min、（7.8±4.8）d、（7.8±1.6）个月、（11.8±2.8）周,两组比较差异无统计学意义（P＞0.05）.术中出血量、手术切口长度在弹性髓内钉组分别为（12.7±3.2） ml、（4.3±1.7） cm,均小于接骨板组（89.2±21.1） ml、（11.6±2.3） cm,两组比较差异有统计学意义（P＜0.05）.两组总并发症发生构成比比较差异无统计学意义（P＞0.05）.按Sanders疗效评定标准,弹性髓内钉组19例,优13例,良3例,可2例,差1例;接骨板组13例,优10例,良2例,可1例,两组比较差异无统计学意义（P＞0.05）.结论：弹性髓内钉和接骨板治疗儿童股骨中上段骨折各有优势,都可以得到很好的骨性愈合和功能恢复,临床选择何种治疗方式需根据骨折类型、体重、患儿家属意愿以及瘢痕大小等综合评估.

Objective：To compare the complications and clinical outcome of titanium elastic nail （TEN） versus platescrew fixation （PF） for the treatment of upper segment fractures of femoral shaft in children.Methods：From May 2006 and August 2012,32 consecutive children with upper segment fractures of femoral shaft were studied prospectively.They were randomly divided into TEN group and PF group.Ninteen patients were treated with titanic elastic nail （TEN） fixation including 11 males and 8 females with an average age of （6.9±2.2） years old ranging from 3 to 11,11 cases of them were type A,6 cases were type B,2 cases were type C according to AO classification.The other 13 patients were treated with plate-screw fixation （PF） including 9 males and 4 females with an average age of （7.5±2.1） years old ranging from 5 to 12 years,and 3 cases of them were type A,6 cases were type B,2 cases were type C.Operative time,blood loss,incision length,the time of hospitalization,fracture healing time,postoperative complications and function recovery between two groups were compared and evaluated.Results：The average follow-up period of the patients was 25.3 months （ranging from 15 to 48 months） in TEN group,and 36.2 months（ranging from 13 to 36 months） in the PF group.The operation time,time of hospitalization,the time of implants removed after the initial surgery,fracture healing time in TEN group were respectively （56.7± 11.2） min,（6.6±3.9） d,（8.1 ±2.3） months,（12.6± 3.8） weeks ;and in PF group were respectively （51.5±8.3） min,（7.8±4.8） d,（7.8±1.6） months,（11.8±2.8） weeks,there was no significant difference between two groups （P＞0.05）.However,the length of incisions was （4.3±1.7） cm and the intraoperative blood loss was （12.7±3.2） ml in TEN group,which were significantly less than that in PF group respectively （89.2±21.1） ml and （11.6±2.3） cm （P＜0.05）.There was no statistically difference in postoperative in complication between two groups,but the patients in TEN group had a higher incidence of soft tissue irritation and misalignment.Outcome scores according to Sanders had no significant difference between two groups （P＞0.05）.In TEN group,the result was excellent in 13 cases,good in 3,fair in 2,and poor in 1,while in PF group excellent in 1 0,good in 2,fair in 1.Conclusion：There is no significant difference in therapeutic effects between TEN and PF for children with upper segment fractures of femoral shaft.The internal fixation should be selected according to the associated fracture type,weight,the expected value of the parents,scars,and so on.