闭合复位经皮克氏针内固定治疗儿童股骨颈骨折

Study of Closed Reduction and K-Wier Internal Fixation Percutaneously on Differnet Types of Femoral Neck Fractures of Children

目的探讨闭合复位经皮克氏针内固定治疗不同类型儿童股骨颈骨折的复位效果、临床疗效和并发症。方法自2008年6月至2013年6月收治儿童股骨颈骨折21例,其中男12例,女9例;年龄3~14岁,平均12.5岁。按Delbet分型,Ⅰ型4例,Ⅱ型10例,Ⅲ型5例,Ⅳ型2例;均为闭合骨折,无合并损伤。所有患者采用C型臂X线机引导下骨折闭合复位,复位满意后经皮克氏针内固定并予以针吸减压。结果所有患儿均得到随访,随访12~28个月,平均18个月。骨折复位评定：Ⅰ型好1例,可2例,差1例;Ⅱ型好3例,可6例,差1例;Ⅲ型好3例,可2例,差0例;Ⅳ型好1例,可1例,差0例。Ratliff评定治疗效果：Ⅰ型优1例,良1例,中1例,差1例;Ⅱ型优7例,良1例,中1例,差1例;Ⅲ型优4例,良1例,中0例,差0例;Ⅳ型优2例,良0例,中0例,差0例。所有患者均骨性愈合,无骨折不愈合,1例骺板早闭,1例髋内翻,1例股骨头坏死,1例针道感染。Ⅰ型骨折并发症明显高于其他类型骨折。结论采用C型臂X线机引导下骨折闭合复位经皮克氏针内固定治疗儿童股骨颈骨折创伤小,治愈率高,疗效可靠。但本组仅有21例患者,样本量较小,长期疗效还需较多病例长期随访观察。

Objective To evaluate the X-ray films,therapeutic efficacy and complications of X-ray guided closed reduction and kirschner wire internal fixation percutaneously on femoral neck fractures of children. Methods From June 2008 to June 2013,21 cases（ male： 12; female： 9） suffering from femoral neck fractures were admitted to our centre for treatment. Their ages ranged from 3 to 14 years old（ average age 12 years 6 months old）. According to Delbet-Colonna classification,4 cases were type Ⅰ,10 cases were type Ⅱ,5 cases were type Ⅲ,2 cases were type Ⅳ. There were no open fractures or associated injuries. All patients underwent X-ray guided closed reduction and kirschner wire internal fixation. Needle aspiration was conducted to further decrease intracapsular pressure. Results All cases were followed up for 12 to 28 months（ average 18 months）.ALL the cases were evaluated by the X-ray films after surgeries： type Ⅰ had 1 case excellent,2 cases good,1 case bad; type Ⅱhad 3 cases excellent,6 cases good,1 case bad; type Ⅲ had 3 cases excellent,2 cases good; type Ⅳ had 1 case excellent,1case good. Evaluated according to Ratliff＇s criteria： type Ⅰ had 1 case excellent,1 case good,1 case fair,1 case poor; type Ⅱhad 7 cases excellent,1 case good,1 case fair,1 case poor; type Ⅲ had 4 cases excellent,1 case good; type Ⅳ had 2 cases excellent. All fractures healed without non-union. 1 case premature physeal closure,1 case occurred coxa vara,1 case occurred avascular necrosis of the femoral head and 1 case infection. The incidence of complications of type Ⅰ fractures was significantly higher than the other type Ⅱ、Ⅲ fractures. Conclusion It is a reliable method with less injury and high cure rate using X-ray guided closed reduction and kirschner wire internal fixation percutaneously to treat femoral neck fractures. But as there are only21 cases,the therapeutic efficacy needed more cases of long-term follow-up observation.