儿童股骨颈骨折疗效及股骨头坏死相关因素分析

The Correlation Factor Analysis of Therapeutic Effect and Femoral Head Avasculer Necrosis for Pediatric Femoral Neck Fractures

目的回顾性分析我院24例儿童股骨颈骨折的临床资料,评价骨折复位质量与股骨头缺血坏死及疗效的关系,评估股骨头坏死的相关因素。方法回顾性分析我院2004年1月至2015年12月收治的24例儿童股骨颈骨折患者,均为闭合性损伤,均采用手术治疗。按Delbet分型,Ⅰ型0例,Ⅱ型7例,Ⅲ型12例,Ⅳ型5例。早期手术11例,延迟手术13例。采用闭合复位16例,切开复位8例。术后功能评价采用Ratliff分级。结果无伤口感染及神经损伤并发症,股骨头缺血坏死4例,骨骺早闭4例,下肢不等长6例,髋内翻4例,骨不愈合3例,内固定失效1例。按Ratliff标准进行疗效评价,优15例,良6例,差3例,优良率87.5%。结论骨折解剖复位、坚强内固定可提高儿童股骨颈骨折患者疗效,骨折复位质量与股骨头缺血坏死、骨不愈合及疗效相关;股骨头缺血坏死与螺钉通过骺板、骨折分型相关;与手术时机、关节囊减压、复位方式无关。

Objective To evaluate the correlation factor between fracture reduction quality and femoral head avasculer necrosis and therapeutic effect and evaluate correlation factor of femoral head avasculer necrosis.Methods We retrospective analyzed the clinical record of 24 paediatric femoral neck fractures in our hospital from January 2004 to December 2015.All were closed fractures and performed operation.There were Delbet type Ⅰ in 0 case,type Ⅱ in 7 cases,type Ⅲ in 12 cases,Type Ⅳ in 5 cases.Early operation was involved in 11 cases,and delayed operation in 13 cases,respectively.Close reduction were involved in 16 cases,and open reduction in 8 cases,respectively.To evaluate postoperation function with Ratliff grade.Results No incision infection and nerve injury happened.There were femoral head avasculer necrosis in 4 cases,premature physeal closure in 4 cases,leg length discrepancy in 6 cases,cox vara in 4 cases,nonunion in 3 cases and implant failure in 1 case.According to Ratliff grade,there were excellent in 15 case,good in 6 cases,bad in 3 cases,with excellent and good rate of 87.5%.Conclusion Fracture anatomic reduction and firm fixation can improve the clinical effect of pediatric femoral neck fractures.Fracture reduction quality is relevant to femoral head avasculer necrosis,nounion and therapeutic effect.Femoral head avasculer necrosis is relevant to transepiphysis screws and fracture subtype,while independent to operation timing,joint decompression and reduction methods.