120°儿童髋锁定加压钢板治疗儿童股骨转子下骨折

120° locking compression paediatric hip plate for femoral subtrochanteric fractures in children

[目的]探讨120°儿童髋锁定加压钢板（120°Locking compression paediatric hip plate,120°LCP PHP）治疗儿童股骨转子下骨折的临床疗效。[方法]2010年10月-2014年5月采用120°LCP PHP治疗儿童股骨转子下骨折16例。[结果]本组患儿术后随访24-36个月,平均（27.3±3.2）个月。无1例发生神经血管损伤、骨折端再移位、再骨折、髋内翻、骨髓炎、股骨头坏死及骨骺发育异常。骨折骨性愈合时间为8-13周,平均（10.1±1.4）周,无骨不愈合。于术后18-32周取出内固定物,平均（25.3±3.4）周。早期Beaty评分及远期Theologis评分皆为满意,术后2年Sanders髋关节评分为57-60分,平均（58.7±2.1）分,都为优,优良率为100%。[结论]120°LCP PHP治疗儿童股骨转子下骨折,具有符合儿童股骨转子下解剖及生物力学特点、固定牢固、避免损伤骨骺、骨折愈合快、并发症少、适应证广、可早期功能锻炼等优点。但存在需要切开复位、损伤相对较大、出血较多、二次手术切开取出内固定物、费用较高、切口瘢痕影响美观等缺点。

[Objective] To investigate the clinical efficacy of 120° locking compression paediatric hip plate in treatment of femoral subtrochanteric fractures in children. [Method]Sixteen skeletally immature idolescents with femoral subtrochanteric fractures were treated with 120° locking compression paediatric hip plate in our department from September 2010 to May 2014.[Result]Patients were followed up for average 27. 3 ± 3. 2 months（ range,24 months to 36 months,average 27. 3 ± 3. 2months）. No complication was found,such as neurovascular injury,fracture re- displacement,re- fracture,varus deformities,osteomyelitis,osteonecrosis and epiphyseal dysplasia. Bone fracture healing time was 8 to 13 weeks,with an average of 10. 1 ±1. 4 weeks,without nonunion being noted. The internal fixation was removed at 18 to 32 weeks after surgery（ average 25. 3 ± 3.4 weeks）. Satisfactory outcomes had been achieved according to short- term Beauty evaluation and long- term Theologis evaluation scoring systems. At two years after surgery,the Sanders hip score result was excellent in all cases（ range,57 to 60 points,mean,58. 7 ± 2. 1）,the excellent outcome rate reached to 100%. [Conclusion]120° locking compression paediatric hip plate in treatment of femoral subtrochanteric fractures has the advantages of consistent with femoral subtrochanteric fractures in children anatomy and biomechanics,reliable fixation,avoiding damaging epiphyseal,early fracture healing,fewer complications,wide- range indications,and possibility for early functional exercises. However,it also has the disadvantages of open reduction,relatively large damage,more bleeding,the second incision removal of internal fixation,and the higher cost,as well as the impact scar appearance.