儿童股骨干骨折外固定复位器的设计及应用

Application of a self-designed external fixation restorer for femoral shaft fractures in children

目的设计应用于儿童股骨干骨折的外固定复位器,观察其在治疗儿童股骨干骨折中的应用效果。方法回顾性研究2016年9月至2017年10月河北医科大学第三医院小儿骨科采用自行设计的外固定复位器辅助复位后弹性髓内钉治疗的19例儿童难复性股骨干骨折患儿资料。患儿男15例,女4例;年龄4岁2个月至8岁,平均6.3岁;横断骨折7例,短斜形骨折11例,斜形骨折1例。复位器直接作用于股骨上进行牵引和临时固定,闭合复位股骨骨折并弹性髓内钉固定。术后根据Flynn等提出的下肢骨折评价标准评价疗效。结果本组患者手术时间32~45 min,平均37 min。所有骨折均获闭合复位,术中均未出现肌肉、神经、血管等软组织牵拉挤压损伤,牵引处未发生骨折或感染。术后随访8~20个月(平均13个月),骨折均获愈合,愈合时间7~15周(平均10.1周)。所有患者无内固定物失效或断裂,术后6~8个月骨折愈合后取出内固定物。末次随访时根据Flynn等提出的下肢骨折评价标准进行评价:优18例,良1例。结论自行设计的儿童股骨干骨折的外固定复位器体积小,操作简便,作用直接,骨折闭合复位质量高,从而避免了骨折切开;且在复位后能够临时固定骨折,可以任意活动股骨透视。

Objective To evaluate a self-designed external fixation restorer used for femoral shaft fractures in children. Methods From September 2016 to October 2017, 19 children were treated at Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University for irreducible femoral shaft fractures using our self-designed external fixation restorer. They were 15 males and 4 females, aged from 4 years and 2 months to 8 years (average, 6.3 years). There were 7 transverse fractures, 11 short oblique fractures and one oblique fracture. The restorer was applied directly to the femur for traction and temporary external fixation. The femoral shaft fractures were reduced closely before internal fixation with elastic stable intramedullary nails. The Flynn criteria for lower limb fracture were used to evaluate the curative effects postoperatively. Results The operative time ranged from 32 to 45 minutes (37 minutes on average). All the fractures obtained closed reduction. No such intraoperative complications occurred as traction and compression injury to soft tissues like muscle, nerve and blood vessel. Follow-ups ranged from 8 to 20 months (average, 13 months). All the fractures got united after 7 to 15 weeks (average, 10.1 weeks). No implant failure or breakage occurred. The implants were removed 6 to 8 months after operation when the fractures got united. According to the Flynn evaluation criteria at the last follow-up, 18 cases were excellent and one was good. Conclusions Due to its advantages of simplicity, easy manipulation and direct action on the femur for traction, our self-designed external fixation restorer can improve the closed reduction for femoral shaft fractures in children so that its sustained and effective traction force and high quality of fracture closure avoid surgical opening. The temporarily fixation it provides after fracture reduction can facilitate intraoperative fluoroscopy of the femur.