闭合与切开复位弹力钉固定儿童不稳定型股骨干骨折

Titanium elastic nail combined with closed reduction versus open reduction through small incision for unstable femoral shaft fractures in children

[目的]比较闭合复位与有限切开复位弹性钉结合尾帽治疗儿童不稳定型股骨干骨折的临床疗效及影像学结果。[方法]回顾性分析本院2012年1月~2016年6月收治的54例年龄5~13岁的股骨干不稳定型骨折患儿资料,其中30例采用闭合复位弹性钉结合尾帽固定(闭合组);24例采用有限切开复位弹性钉结合尾帽固定(切开组)。比较两组患儿的围手术期、随访和影像资料。[结果]两组患者手术均顺利,术中无神经、血管损伤。切开组手术时间及术中平均透视时间均明显小于闭合组(P<0.05),但两组在术中失血量、住院时间差异无统计学意义(P>0.05)。随访20~25个月,平均(22.28±1.65)个月。两组患者在术后部分负重时间、骨折愈合时间和末次随访时Harris评分的差异均无统计学意义(P>0.05)。随访过程中,出现退针钉尾激惹闭合组4例,切开组1例,均在骨折愈合取出弹性钉后症状完全消失。末次随访时,成角>5°者闭合组8例,切开组3例;两组均无旋转畸形;下肢长度差异>1cm者闭合组8例,切开组4例。两组患儿均无骨折不愈合、延迟愈合,弹性钉取出后无再发骨折,无髋、膝关节活动受限等并发症。影像评估方面,切开组Beaty评级满意率(91.67%)显著高于闭合组(53.33%)(P<0.05);切开组Flynn髓内钉疗效评级优秀率(62.50%)显著高于闭合组(16.67%)(P<0.05)。[结论]有限切开复位弹性钉结合尾帽固定治疗不稳定型儿童股骨干骨折可以获得更好的骨折对位与固定,并发症更少,而且明显缩短了手术时间及放射线暴露,是一种更为优良的治疗方法。

[Objective]To compare the clinical outcomes of unstable femoral shaft fractures treated by titanium elastic nail ing combined with closed reduction versus limited open reduction in children.[Methods]A retrospective study was conducted on 54 children who aged 5-13 years and underwent surgical treatment with titanium elastic nail for unstable femoral shaft frac tures from January 2012 to June 2016.Based on reduction approach used,30 patients had the nail inserted percutaneously com bined with closed reduction,while the other 24 patients had the internal fixation conducted combined with open reduction through a small incision.The perioperative,follow-up and radiographic documentations were compared between the two groups.[Results]All the patients in both groups received successful operations without iatrogenic neurovascular injuries.The open group prove significantly superior to the closed group in operation time and fluoroscopic time(P<0.05),regardless of no statisti cally significant differences between the two groups in intraoperative blood loss and hospital stay(P>0.05).The follow up peri od lasted for 20~25 months with a mean of(22.28±1.65)months.There were no statistically significant differences regarding to partial weight bearing times,fracture healing time and Harris scores at the latest follow up between the two groups(P>0.05).During the follow up period,withdrawing of nail leaded to local irritation happened in 4 patients of the closed group,whereas on ly 1 patient of the open group.To the latest follow up,femoral angulation more than 5 degrees was noted in 8 patients of the closed group,while only 3 patients of the open group;addi tionally,length discrepancy of both low extremities more than 1 cm occurred in 8 children of the closed group,whereas 4 cases of the open group.No rotation deformity,fracture nonunion or delayed union,refracture after nail removed,and limitation of hip and knee range of motion were found in any patient of both groups.With respect of radiographic assessment,the satisfactory rate was of 53.33%in the closed groups,but 91.67%in the open group in term of Beaty's criteria,which was statistically significant(P<0.05).On the other hand,the excellent rate proved of 16.67%in the closed group,whereas 62.50%in the open group,which was of a significant difference.[Conclusion]The limited open reduction has advantages of improvement of regaining alignment,reducing complication,saving operation time and decreasing radioactive exposure over the closed reduction in elastic nailing for unstable femoral shaft fracture in children.