闭合复位联合Taylor三维空间支架固定治疗儿童股骨髁上骨折

Closed reduction combined with Taylor three-dimensional space stent fixation for supracondylar femoral fracture in children

目的探讨闭合复位联合Taylor三维空间支架固定治疗儿童股骨髁上骨折的疗效及安全性。方法 2008年7月—2016年7月,采用闭合复位联合Taylor三维空间支架固定治疗儿童股骨髁上骨折20例。其中男14例,女6例;年龄6～14岁,平均10.3岁。致伤原因:交通事故伤5例,高处坠落伤6例,摔伤9例。均为闭合性骨折;屈曲型12例,伸直型8例。根据AO分型:A1型12例,A2型8例。骨折位于骨骺线上0.5～5.0 cm,平均2.5 cm。受伤至手术时间2～8 d,平均3.5 d。术后采用膝关节Kolment评定标准评价膝关节功能。结果术后患儿均获随访,随访时间6～24个月,平均18.1个月。术后均无钉道感染、血管神经损伤、外固定架松动、骨折移位、再骨折等并发症发生。所有骨折均愈合,愈合时间4～6周,平均4.5周。拆除支架时间为8～12周,平均9.5周。患儿无跛行步态,膝关节功能恢复良好,无骨骺发育异常。末次随访时,参照膝关节Kolment评定标准,膝关节功能获优18例、良2例,优良率为100%。结论闭合复位联合Taylor三维空间支架固定治疗儿童股骨髁上骨折,具有创伤小、恢复快、能避免对骺板的损伤,骨折愈合率高,能促进患肢功能恢复等优点,是有效治疗手段之一。

Objective To explore the effectiveness and safety of closed reduction combined with Taylor threedimensional space stent fixation in treatment of supracondylar femoral fractures in children. Methods Between July 2008 and July 2016, 20 patients with supracondylar femoral fractures were treated with closed reduction combined with Taylor three-dimensional space stent fixation. There were 14 males and 6 females, with an average age of 10.3 years (range, 6-14 years). The cause of injury was traffic accident in 5 cases, falling from high place in 6 cases, and falling in 9 cases. All fractures were closed fractures. Among them, 12 cases were flexion type and 8 cases were straight type. According to AO classification, 12 cases were rated as type A1 and 8 cases as type A2. The fractures were over 0.5-5.0 cm (mean, 2.5 cm) of the epiphysis line. The time from injury to surgery was 2-8 days (mean, 3.5 days). Postoperative knee joint function was evaluated based on the Kolment evaluation criteria. Results All children were followed up 6-24 months (mean, 18.1 months). There was no complication such as nail infection, vascular nerve injury, external fixation looseing, fracture displacement, or re-fracture. All fractures healed and the fracture healing time was 4-6 weeks with an average of 4.5 weeks. The stent removal time was 8-12 weeks (mean, 9.5 weeks). The gait and knee function recovered, and there was no abnormality of the epiphysis. At last follow-up, the knee joint function were excellent in 18 cases and good in 2 cases according to the Kolment evaluation criteria, and the excellent and good rate was 100%. Conclusion Closed reduction combined with Taylor three-dimensional space stent fixation is an effective treatment for the children with supracondylar femoral fractures, with small trauma and rapid recovery. It can avoid damaging the tarsal plate, be high fracture healing rate, and promote the recovery of limb function.