三种内固定方式治疗儿童移位型股骨颈骨折的临床分析

Comparison of three internal fixation techniques for treating displaced femoral neck fractures in children

目的比较克氏针、空心螺钉、小儿髋部锁定加压接骨板（LCP）治疗儿童移位型股骨颈骨折的临床疗效。方法采用回顾性病例对照研究分析2010年1月-2015年8月收治且获得随访的56例儿童移位型股骨颈骨折患者临床资料。均为闭合复位失败后改行切开复位内固定。根据内固定方式将患者分为克氏针组（18例）、空心螺钉组（21例）和小儿髋部LCP组（LCP组，17例）。比较三组手术时间、术中出血量、颈干角丢失、骨折愈合时间、术后并发症及末次随访时Ratliff功能评定结果和髋关节Harris评分等。结果克氏针组、空心螺钉组和LCP组手术时间分别为（74．2±12．9）min、（90．2±18．9）min、（125．1±20．6）min，术中出血量分别为（27．3±15．4）ml、（32．4±18．7）ml、（57．7±22．1）ml，颈干角丢失分别为（3．74±0．80）°、（2．96±0．74）°、（1．22±0．39）°。克氏针组手术时间、术中出血量明显优于其他两组，LCP组在防止颈干角丢失上明显优于其他两组（P〈0．05）。克氏针组1例出现骨不连并发髋内翻畸形。克氏针组、空心螺钉组与LCP组股骨头缺血性坏死的发生率分别为11％、14％、12％（P〉0．05）。三组随访时间、骨折愈合时间、末次随访时Ratliff功能评定结果和髋关节Harris评分比较差异均无统计学意义（P〉0．05）。术后无一例发生骨骺早闭、医源性血管神经损伤或骨筋膜间隔综合征。结论三种内固定治疗闭合复位失败的儿童移位型股骨颈骨折均可取得良好的临床效果。克氏针具有术中出血量少、手术时间短、操作简便等优势；空心螺钉在术中情况和术后并发症方面无明显优劣势；小儿髋部LCP能减少颈干角丢失，减少髋内翻畸形的发生。

Objective To compare the clinical efficacy of three internal fixation techniques, namely K-wire, hollow screw and pediatric hip locking compression plate （LCP） , for treating displaced femoral neck fractures in children. Methods The clinical data of 56 patients treated from January 2010 to August 2015 were retrospectively analyzed by case-control study. All the patients received open reduction after unsuccessful closed reduction. According to the methods of internal fixation, the patients were divided into K-wire group （18 cases） , hollow screw group （21 cases） and LCP group （17 cases）. Operation time, intraoperative blood loss, neck-shaft reduction, bone union time, and complications after surgery were recorded. Ratliff and Harris scores at final follow-up visit were evaluated. Results In K- wire group, hollow screw group and LCP group, the operation times were respective（74.2 ±12.9） min, （90.2 ±18.9） min and （125. 1 ±20.6） min, the intraoperative blood loss of the three groups were respective （27.3 ± 15.4） ml, （32.4 ±18.7 ） ml and （57.7 ±22.1 ） ml, and the neck shaft reduction of the three groups were respective （ 3.74 ± 0.80）°, （ 2.96 ±0.74）° and （ 1.22 ±0.39 ）°. K-wire group were superior to other two groups in operation time and intraoperative blood loss, and PHP group were better than the other two groups in prevention of neck-shaft reduetion（P 〈0.05）. There was one case in K-wire group with bone nonunion combined with hip varus. In K-wire group, hollow screw group and LCP group, the avascular necrosis were 11%, 14% and 12%, respectively （P 〉 0.05）. There were no statistically significant differences in follow-up time, bone union time, and Ratliff as well as Harris scores among the three groups （ P 〉 0. 05 ）. The case of epiphyseal premature closure, iatrogenic injury of blood vessel and nerve as well as osteo-fascial compartment syndrome was not observed after surgery. None of the patients had epiphyseal close, neurovaseular injury and osteofacial compartment syndrome. Conclusions All three internal fixation techniques can have good clinical results in children with displaced femoral neck fractures after unsuccessful closed reduction. K-wire has advantages of less blood loss, shorter operation time and easier handling. Hollow screw has no obvious advantages or disadvantages in intraoperative situation and postoperative complications. Pediatric hip LCP can reduce the loss of neck- shaft angle and decrease the occurrence of hip varus.