大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折疗效观察

Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent

目的探讨大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折的疗效。方法 2011年6月—2015年6月,采用闭合复位大粗隆顶点开口顺行带锁髓内钉治疗23例青少年股骨干骨折。其中男19例,女4例;年龄13岁6个月~17岁,平均15.2岁。体质量40~77 kg,平均53.5 kg。致伤原因:交通事故伤13例,运动伤7例,摔伤3例。骨折位置:股骨干上1/3 6例,中1/3 10例,下1/3 7例。骨折类型:横形骨折10例,斜形骨折6例,螺旋形骨折1例,粉碎性骨折6例。受伤至手术时间3~17 d,平均6.2 d。末次随访时于双下肢全长X线片,测量双下肢长度、颈干角、股骨颈直径、股骨头最高点平面与股骨大粗隆顶点平面间距离(articulotrochanteric distance,ATD)。结果患者术后切口均Ⅰ期愈合,无感染等早期并发症发生。23例均获随访,随访时间15~36个月,平均26.5个月。术后患者均无疼痛,步态正常,无跛行,均恢复日常生活及运动。X线片复查示,骨折均愈合,临床愈合时间5~13个月,平均6.5个月;均无骨折不愈合、延迟愈合及超过5°的畸形愈合、旋转畸形发生。术后12~24个月取出内固定物,平均19.5个月。随访期间无异位骨化及再骨折发生,无股骨近端发育畸形及股骨头缺血性坏死发生。2例术后大粗隆骨骺早闭,但步态无影响;2例双下肢不等长,但双下肢差值<1 cm;均无需手术处理。末次随访时健、患侧颈干角分别为(131.7±6.3)、(132.9±7.8)°,股骨颈直径分别为(34.1±3.2)、(33.9±3.8)mm,ATD分别为(27.8±9.2)、(26.5±8.5)mm,比较差异均无统计学意义(t=–0.24,P=0.86;t=0.18,P=0.92;t=1.03,P=0.49)。结论大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折固定可靠,是一种有效的手术方法。

Objective To explore the effectiveness of rigid interlocking nails through the tip of the greater trochanter for fixation of femur shaft fracture in adolescent. Methods A retrospective analysis was made on the clinical data of 23 adolescents with femoral shaft fractures treated between June 2011 and June 2015. Of 23 cases, 19 were male and 4 were female, aged from 13 years and 6 months to 17 years （mean, 15.2 years）, weighed from 40 to 77 kg （mean, 53.5 kg）. The causes were traffic accident injury in 13 cases, sports injury in 7 cases, and falling injury in 3 cases. Fracture located at the proximal 1/3 in 6 cases, middle 1/3 in 10 cases, and distal 1/3 in 7 cases; fracture was typed as transverse in 10 cases, oblique in 6 cases, spiral in 1 case, and comminuted in 6 cases. The course of disease was 3-17 days （mean, 6.2 days）. At last follow-up, the leg length discrepancy, femoral neck shaft angle, femoral neck diameter, and articulotrochanteric distance （ATD） were measured on the X-ray films. Results Wounds healed in all patients, and no infection occurred. All patients were followed up 15-36 months （mean, 26.5 months）. The patients had no pain and had normal gait, without lameness. The X-ray films showed bone healing at 5-13 months （mean, 6.5 months）. No nonunion, delayed union,malunion of more than 5°, or rotational deformity occurred. The removal time of internal fixations was 12-24 months （mean, 19.5 months） after operation. No heterotopic ossification, re-fracture, proximal femoral deformity, or femoral head necrosis occurred during follow-up. Two patients had early epiphyseal closure of greater trochanter, which had no impact on gait; leg-length inequality of less than 1 cm was observed in 2 cases. At last follow-up, the neck shaft angle, femoral neck diameter, and ATD of normal and affected sides were （131.7±6.3） and （132.9±7.8）°, （34.1±3.2） and （33.9_±3.8） mm, and （27.8±9.2） and （26.5±8.5） mm, showing no significant difference between two sides （t=-0.24, P=0.86; t=0.18, P=0.92; t=1.03, P=0.49）. Conclusion It is a reliable and effective method to use rigid interlocking nails inserted through the tip of the greater trochanter for the flxation of femur shaft fracture in adolescent.