弹性髓内钉治疗大龄儿童股骨干骨折效果观察

Efficacy of elastic stable intramedullary nail in the treatment of femoral shaft fracture of older children

目的观察弹性髓内钉(TEN)内固定术治疗大龄儿童股骨干骨折的安全性和有效性。方法将43例大龄儿童股骨干骨折患者随机分为观察组(23例)和对照组(20例)。观察组采用闭合复位弹性髓内钉内固定治疗,对照组采用切开复位接骨板内固定治疗。记录手术时间、术中出血量、切口长度、住院天数以及临床预后指标,包括骨折愈合时间、双下肢不等长、成角畸形。按照Flynn等提出的下肢骨折评价标准进行疗效评价。结果两组患者均获随访,随访时间12~24个月,平均14.36个月,末次随访影像学检查显示骨折均愈合,无内固定失效、神经损伤、深部组织感染、股骨头坏死等其他严重并发症发生;两组手术时间、术中出血量、切口长度、住院天数及骨折愈合时间比较,差异有统计学意义(P<0.05);两组双下肢不等长、成角畸形及术后功能比较,差异无统计学意义(P>0.05)。结论 TEN内固定术治疗大龄儿童股骨干骨折可有效缩短手术时间、减少出血量,疗效确切。

Objective To evaluate the safety and efficacy of elastic stable intramedullary nail(TEN)in the treatment of femoral shaft fracture in older children.Methods 43 cases of older children with femoral shaft fracture were randomly divided in the observation group(23 cases)and the control group(20 cases).The observation group were treated with closed TEN internal fixation and the contol group were treated with open bone plate internal fixation.The operation time,intraoperative blood loss,incision length,hospitalization time and clinical prognosis including bone healing time,leg length discrepancy and angulation deformity were recorded.The clinical efficacy was evaluated according to criteria for evaluation of lower limb fractures proposed by Flynn et al.Results Both groups of patients were followed up for 12~24 months,with an average of 14.36 months.The last follow-up'imaging examination showed that the fracture was healed without complications such as internal fixation failure,nerve damage,deep tissue infection and femoral head necrosis.The comparison of operation time,intraoperative blood loss,incision length,hospitalization time and fracture healing time had statistically significant diffeence between the two groups(P<0.05).The comparison of leg length discrepancy,angulation deformity and postoperative function had no statistically significant diffeence between the two groups(P>0.05).Conclu⁃sion TEN internal fixation in the treatment of femoral shaft fractures of older children can effectively shorten the opera⁃tion time and reduce the amount of bleeding.