开放与闭合复位延迟治疗儿童股骨颈骨折的比较

Comparison of open versus closed reduction and internal fixation for late-treated femoral neck fracture in children

[目的]探讨开放与闭合复位是否会对儿童股骨颈骨折的延迟治疗结局产生不同的影响。[方法]收集2005年1月~2016年1月在本院儿骨科接受治疗的47例超过36 h复位的股骨颈骨折患儿,其中男28例,女19例。根据Delbet分类,I型1例,II型30例,III型11例,IV型5例。根据复位方式不同分为开放组(32例)和闭合组(15例)。随访采用Ratliff分级标准,并发症评估包括股骨头坏死、髋内翻及骺板早闭等。[结果]两组手术时间差异无统计学意义(P>0.05),但闭合组失血量明显少于开放组,差异有统计学意义(P<0.05)。所有患儿随访12~48个月,平均17个月。开放组9例发生股骨头坏死(28.12%),其中I型6例,II型2例,III型1例。2例(6.25%)患儿出现髋内翻,其中1例在术后20个月后行二次手术以纠正髋内翻畸形;1例(3.13%)发生骺板早闭。闭合组中发生股骨头坏死仅2例(13.33%),均为Ratliff股骨头坏死I型,未出现髋内翻等其他并发症。Ratliff评价标准,开放组优秀71.88%(23/32),良好28.12%(9/32);闭合组优秀80.00%(12/15),良好20.00%(3/15),两组优良率比较差异无统计学意义(P>0.05)。[结论]闭合复位和开放复位内固定对于延迟治疗的儿童股骨颈骨折都是有效的方法,但闭合复位内固定治疗的并发症发生率相对较少。股骨头坏死为儿童股骨颈骨折的主要并发症。

[Objective] To compare clinical outcome of open versus closed reduction combined with internal fixation for treatment of late-treated femoral neck fracture in the children. [Methods] A retrospective study was performed on 47 children with femoral neck fracture who were delayed more than 36 hours for surgical intervention, including 28 boys and 19 girls. In term of Delbet＇s classification, there were 1 patient of type I, 30 type II, I 1 type III, and 5 type IV. Of the patients, 32 were treated with open reduction combined with internal fixation （the ORIF group）, while the remaining 15 patients were treated withclosed reduction with internal fixation （the CRIF group） . Complications, such as femoral head necrosis, coxa vara, and early epiphyseal closure were observed, additionally, clinical outcome was evaluated using Ratliff criteria. [Results] No sta- tistical difference was noted in operation time between thetwo groups, however, intraoperative blood loss in the ORIF group was significantly larger than the CRIF group （P〈0.05） All the patients were followed up from 12 to 48 months with a mean of 17 months. Avascular necrosis （AVN） of the femoral head was noted in 9 patients （28.12%） of the ORIF group, including Type I in 6 patients, Type II in 2 and Type III in 1. In addition, coxa vara occurred in 2 patients, 1 of them underwent secondary osteotomy to correct the deformity, and early epiphyseal closure hap- pened in 1 patient of the ORIF group. By contrast, only AVN of the head graded as Type I was found in 2 patients of the CRIF group without coxa vara or early epiphyseal closure in any patient of the CRIF group. According to the Ratliff＇s criteria, the re- suits were graded as the excellent in 71.88% （23/32） and the good in 28.12% （9/32） of the ORIF group, whereas the excellent in 80.00% （12/15） and the good in 20.00% （3/15） of the CRIF group, without statistical difference was recorded between the two groups （P〉0.05） . [Conchmion] Although both open and closed reduction with internal fixation are effective treatment options for delayed femoral neck fracture in children, the closed technique gets relatively less complication rate. AVN of the femoral head appears as the primary complication secondary to the late-treated femoral neck fracture in children.