长骨牵开器在弹性髓内钉治疗儿童股骨干骨折中的应用

Application of long bone retractor in the treatment of femoral shaft fracture in children with elastic intramedullary nail

目的探讨长骨牵开器在弹性髓内钉治疗儿童股骨干骨折中的应用效果。方法采用长骨牵开器辅助复位弹性髓内钉治疗15例儿童股骨干骨折。记录手术情况、骨折愈合情况、关节活动度及并发症发生情况,根据Flynn et al提出的下肢骨折评分标准评估疗效。结果手术时间31~65 min,术中出血量5~15 ml,术中透视7~15次,住院时间2~6 d。术中无血管神经以及肌肉牵拉伤,牵拉置入斯氏针处无骨折以及渗出感染。患儿均获得随访,时间5~18个月。骨折均愈合,时间9~18周。末次随访时,患儿均可下地完全负重行走,无跛行,内固定无失效断裂,下地负重后无大腿疼痛、局部压痛以及纵向叩击痛;髋关节屈曲130°~135°,膝关节伸直0°~5°、屈曲120°~140°;根据Flynn et al提出的下肢骨折评分标准评估疗效:优13例,良2例。结论弹性髓内钉治疗儿童股骨干骨折中采用长骨牵开器辅助复位操作简便,复位质量可靠,同时能维持骨折断端复位,方便弹性髓内钉的置入,疗效较好。

Objective To investigate the application effect of long bone retractor in the treatment of femoral shaft fractures in children with elastic intramedullary nails.Methods The 15 cases of femoral shaft fractures in children were treated with elastic intramedullary nail assisted by long bone retractor.The operation condition,fracture healing,joint motion and complications were recorded,and the efficacy was evaluated with the lower limb fracture scoring criteria proposed by Flynn et al.Results The operation time was 31~65 min,the intraoperative blood loss was 5~15 ml,the intraoperative fluoroscopy was 7~15 times,and the hospital stay was 2~6 d.During the operation,there were no vascular,nerve and muscle pulling injuries,and no fracture or exudation infection occurred at the site where the Steinmann pin was placed.All patients were followed up for 5~18 months.All fractures healed within 9~18 weeks.At the last follow-up,the children could walked with full weight-bearing,without limping,there was no failure or rupture of internal fixation,and no thigh pain,local tenderness or longitudinal percussion pain after loading.Hip flexion was 130°~135°,knee extension was 0°~5°,and flexion was 120°~140°;according to the lower limb fracture scoring criteria proposed by Flynn et al,13 cases were excellent and 2 cases were good.Conclusions In the treatment of femoral shaft fractures in children with elastic intramedullary nails,the use of long bone retractor assisted reduction is simple,reliable,which can maintain the reduction of the broken end of the fracture,facilitating the insertion of elastic intramedullary nails,and has a good effect.