髋锁定加压钢板与弹性髓内钉内固定治疗儿童股骨粗隆下骨折的疗效比较

Comparison of clinical efficacy of LCP-PHP and TEN for femoral subtrochanteric fractures in children

目的比较儿童髋锁定加压钢板与弹性髓内钉内固定治疗儿童股骨粗隆下骨折的临床疗效。方法纳入自2010-05—2013-12诊治的31例儿童股骨粗隆下骨折,15例采用儿童髋锁定加压钢板内固定(钢板组),16例采用弹性髓内钉内固定(髓内钉组)。比较2组手术时间、术中出血量、X线透视次数、切口长度、住院时间、骨折愈合时间,术后1个月Beaty放射学结果,术后2年Theologis放射学结果,以及术后2年髋关节功能Sanders评分。结果钢板组获得平均27.3(24~32)个月随访,髓内钉组术后获得平均27.8(24~34)个月随访。与髓内钉组比较,钢板组手术时间与骨折愈合时间更短、X线透视次数更少、术后1个月Beaty结果满意率更高、并发症发生率更低,但手术切口更长、术中出血量更多、住院时间更长,差异有统计学意义(P<0.05);2组术后2年Theologis结果、髋关节功能Sanders评分差异无统计学意义(P>0.05)。结论儿童股骨粗隆下骨折采用切开复位儿童髋锁定加压钢板内固定可取得满意疗效,骨折端获得解剖复位后更有利于骨折愈合,钢板固定后能维持骨折对位并保证固定强度,患儿可早期进行功能锻炼,并发症发生率低。

Objective To compare the clinical outcomes of locking compression pediatric hip plate(LCP-PHP) and titanic elastic nail(TEN) for femoral subtrochanteric fractures in children. Methods Thirty-one patients with femoral subtrochanteric fractures were treated from May 2010 to December 2013, 15 cases with LCP-PHP(LCP-PHP group), and 16 cases with TEN(TEN group). The operative time, intraoperative blood loss, fluoroscopy times, incision length, length of hospital stay, fracture healing time, the results of Beaty radiology at 1 month after the operation, the results of Theologis radiology 2 years after operation, and the Sanders score of the hip joint function 2 years after operation were compared.Results Patients in the LCP-PHP group received an average of 27.3(range, 24-32) months of follow-up while the TEN group received an average of 27.8(range, 24-34) months of follow-up. Compared with the TEN group, the LCP-PHP group had shorter operative time and fracture healing time, fewer fluoroscopy times, a higher rate of satisfaction with the results of Beaty at 1 month after operation, and a lower complication rate, but the surgical incision was longer. There was more intraoperative blood loss and longer hospital stay. The difference was statistically significant(P <0.05). There was no significant difference in the results of Theologis and hip function Sanders score between the two groups(P >0.05).Conclusion The treatment of children's femoral subtrochanteric fracture with open reduction and internal fixation with LCP-PHP can achieve satisfactory results. The fracture end is more beneficial to fracture healing after anatomical reduction.LCP-PHP can maintain the fracture alignment and ensure the fixed strength. The children can exercise early, and the incidence of complications is low.