儿童髋部钢板结合克氏针治疗儿童股骨颈伴大转子撕脱性骨折

Fixation with Kirschner wires plus pediatric hip plate for femoral neck fracture combined with avulsion fracture of the greater trochanter in children

目的探讨儿童髋部钢板（PHP）结合克氏针治疗儿童股骨颈伴大转子撕脱性骨折的可行性和临床疗效。方法回顾性分析2014年2月至2016年2月南京医科大学附属儿童医院骨科采用PHP结合克氏针固定治疗的6例儿童股骨颈伴大转子撕脱性骨折患儿资料，男4例，女2例；年龄3．5～11．1岁，平均7．2岁。骨折按Delbet’s分类，均为Ⅲ型股骨颈骨折，同时伴大转子撕脱性骨折。末次随访时根据Ratliff评分标准评定疗效。结果术中出血量为20～50mL，平均30mL。手术时间为45—60min，平均55rain。伤口均一期愈合。6例患儿术后获12～36个月（平均26个月）随访，所有患儿均获骨性愈合，愈合时间为6—8周（平均7周）。末次随访时根据Ratliff功能评分标准评定疗效：良5例，可1例。所有患儿均无神经、血管损伤发生，无伤口感染发生。1例患儿大转子骨折块未能达到精确解剖复位，但无不良后果。结论PHP结合克氏针能够成功治疗儿童股骨颈伴大转子撕脱性骨折，疗效较好。

Objective To investigate the feasibility and clinical effectiveness of fixation with Kirschner wires plus pediatric hip plate （PHP） for femoral neck fracture combined with avulsion fracture of the greater trochanter in children. Methods Between February 2014 and February 2016, 6 children were treated by fixation with Kirschner wires plus PHP for femoral neck fracture combined with avulsion fracture of the greater trochanter at Department of Pediatric Orthopaedics, Children＇s Hospital, Nanjing Medical University. They were 4 boys and 2 girls, aged from 3.5 to 11.1 years （mean, 7.2 years） . By the Delbet＇s classification, all the fractures were of type Ⅲ. Clinical efficacy was evaluated according to the Ratliff scoring system at the last follow-ups. Results The intraoperative bleeding ranged from 20 to 50 mL （average, 30 mL）; the operation time ranged from 45 to 60 min （average, 55 min） . All the patients were followed up for 12 to 36 months （average, 26 months） . Bony union was obtained in all cases after an average time of 7 weeks （from 6 to 8 weeks） . The Ratliff scores at the last follow-ups showed 5 good and one acceptable cases, No neurovascular lesion or incision infection was observed in the children. Anatomical reduction of the greater trochanter fracture was not achieved in one child but led to no adverse effect. Conclusion Fixation with Kirschner wires plus PHP can successfully treat femoral neck fracture combined with avulsion fracture of the greater trochanter in children.