AAOS《儿童股骨干骨折治疗指南》解读

Interpretation of American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures

2009年美国矫形外科医师协会（AAOS）制定了《儿童股骨干骨折治疗指南》，2015年根据新的指南制定标准对其进行了更新。新版指南根据现有文献未增加新的推荐建议，剔除了原指南保留的＂尚不能确定的推荐意见＂ ，保留了7项推荐建议：（1）对〈6个月的股骨干骨折患儿，推荐使用Pavlik支具或髋人字石膏固定；（2）对〈36个月的股骨干骨折患儿，应评估是否由虐待导致；（3）对6个月至5岁、短缩〈2 cm的股骨干骨折患儿，推荐使用早期髋人字石膏固定或牵引后延期使用髋人字石膏固定；（4）制作石膏时，推荐使用防水衬垫；（5）对5-11岁的股骨干骨折患儿，推荐选用弹性髓内钉治疗；（6）对11岁至骨骼成熟阶段儿童的股骨干骨折，推荐使用经转子开口的刚性髓内钉、接骨板和弹性髓内钉治疗；（7）对儿童股骨干骨折患者推荐进行局部疼痛控制以改善围手术期舒适度。本文对新版指南进行了解读，以期为骨科医师诊治儿童股骨干骨折提供参考。

The original guideline on the Treatment of Pediatric Diaphyseal Femur Fractures （PDFF） was developed by the American Academy of Orthopaedic Surgeons （AAOS） in 2009, and the guideline was updated by AAOS in 2015. In this reissue, all recommendations in the original guideline identified as ＂inconclusive＂ were removed with seven recommendations reserved and without new recommendations added. The recommendations in the current guideline were listed as follows ： （ 1 ） Children younger than 36 months with PDFF should be evaluated for child abuse. （2） Pavlik hamess or spica cast might be used for infants 6 months and younger with a PDFF. （3） Early spica casting or traction with delayed spica casting could be used for children aged from 6 months to 5 years with a PDFF with less than 2 cm of shortening. （4） Waterproof cast liners might be used for spica casts. （5） Flexible intramedullary nailing might be sugested to treat children aged from 5 to 11 years with PDFF. （6） Rigid trochanteric entry nailing, submuscular plating, and flexible intramedullary nailing might be treatment options for children aged over 11 years to skeletal maturity with PDFF. （7） Regional pain management could be used for patient comfort perioperatively. This paper makes interpretation for this guideline with the aim to provide reference for pediatric surgeons to select appropriate treatment methods for patients with PDFF.