骨折复位器与手法牵引治疗儿童股骨骨折疗效分析

Therapeutic efficacies of femoral fractures by external fixation restorer versus manual traction reduction in children

目的探讨骨折复位器复位和手法牵引复位对弹性钉治疗儿童股骨骨折效果的影响。方法采用回顾性病例对照研究分析2016年10月至2019年4月收治的49例儿童股骨骨折临床资料。根据治疗方式不同分为骨折复位器组(应用骨折复位器复位,25例)和手法牵引组(应用手法牵引复位,24例),均采用钛弹性髓内钉固定。比较两组闭合复位成功率、手术时间、透视时间、失血量等变化,并评价患儿术后患肢功能恢复情况。结果骨折复位器组25例中24例(96.0%)闭合复位成功,手法牵引组24例中13例(54.2%)闭合复位成功,两组闭合复位成功率比较,差异有统计学意义(P<0.05)。骨折复位器组手术时间(41.8±6.5)min、透视时间(21.1±5.8)s和出血量(12.2±7.2)ml,均少于手法牵引组的(49.7±8.4)min、(26.3±6.4)s和(23.0±13.9)ml,组间比较,差异均有统计学意义(P均<0.05)。末次随访时,骨折复位器组25例股骨骨折评分优23例、良2例,手法牵引组24例优22例、良2例,两组优良率均为100%。结论对于应用弹性髓内钉治疗的儿童股骨骨折,骨折复位器较手法牵引复位闭合复位成功率高,可缩短手术时间、放射暴露时间并减少术中出血量。

Objective To explore the therapeutic efficacies of fracture reductor reduction versus manual traction reduction for femoral fracture with elastic nail in children.Methods For this retrospective case-control study,a total of 49 children of femoral fractures undergoing titanium elastic intramedullary nailing from October 2016 to April 2019.Based upon different treatments,they were assigned into fracture restorer group(external fixation redactor,n=25)and manual traction group(manual traction,n=24).The success rate of closed reduction,operative duration,fluoroscopic time and intraoperative blood loss were compared between two groups.Postoperative follow-up evaluations for limb function were performed according to the criteria of Flynn.Results In fracture restorer group,24/25 children achieved closed reduction and 13/24 in manual traction group.Significant inter-group difference existed in success rate of closed reduction(P<0.05).Operative duration(41.8±6.5)min,fluoroscopic time(21.1±5.8)s and blood loss(12.2±7.2)ml were less in fracture restorer group than those in manual traction group[(49.7±8.4)min,(26.3±6.4)s&(23.0±13.9)ml]and the differences were statistically significant(P<0.05).At the last follow-up,femoral fracture score of fracture restorer group was excellent(n=23)and decent(n=2)while the excellent and decent rate was 100%for both groups.Conclusions For pediatric femoral fractures with elastic intramedullary nailing,fracture restorer may achieve a higher rate of closed reduction than manual traction reduction.It also offers the advantages of shorter operative duration,less fluoroscopic time and smaller intraoperative blood loss.