闭合复位与切开复位空心钉内固定治疗儿童股骨颈骨折疗效比较

Closed versus open reduction internal fixation with cannulated screws for displaced femoral neck fractures in children

目的比较闭合复位与切开复位空心钉内固定治疗儿童股骨颈骨折的临床疗效。方法回顾性分析2014-01-2020-01诊治的62例儿童DelbetⅡ、Ⅲ型股骨颈骨折,34例采用闭合复位3枚空心钉内固定(闭合复位组),28例采用切开复位3枚空心钉内固定(切开复位组)。比较两组手术时间、术中X线透视次数、术中出血量、住院时间,骨折复位质量、Ratliff评分、髋关节功能Harris评分、并发症情况。结果闭合复位组手术时间较切开复位组短,术中出血量较切开复位组少,而切开复位组骨折复位质量优于闭合复位组,差异有统计学意义(P<0.05)。闭合复位组与切开复位组术中X线透视次数、住院时间差异无统计学意义(P>0.05)。闭合复位组术后随访时间为24~47个月,平均32.7个月。切开复位组术后随访时间为24~55个月,平均35.4个月。闭合复位组与切开复位组骨折愈合时间、末次随访Ratliff评分结果、末次随访时髋关节功能Harris评分差异无统计学意义(P>0.05)。随访期间闭合复位组5例发生股骨头缺血性坏死,1例发生髋内翻畸形,1例发生骺板早闭。切开复位组3例发生股骨头缺血性坏死,1例发生骺板早闭,但未发生髋内翻畸形。结论闭合复位和切开复位空心钉内固定均可有效治疗儿童DelbetⅡ、Ⅲ型股骨颈骨折,早期手术并不能降低股骨头缺血性坏死发生风险。临床医师在术中应重视解除关节囊内高压,手法及撬拨复位骨折失败后需立即切开复位,降低并发症发生率。

Objective To compare the clinical efficacy of closed versus open reduction and cannulated screws in the treatment of displaced femoral neck fractures in children.Methods Sixty-two children with Delbet type II and II femoral neck fractures diagnosed and treated from January 2014 to January 2020 were retrospective analyzed.Thirty-four cases were treated with closed reduction and internal fixation with 3 cannulated screws(closed reduction group)while 28 cases were treated with open reduction and internal fixation with 3 cannulated screws(open reduction group).The operation time,intraoperative X-ray fluoroscopy times,intraoperative blood loss,hospital stay,fracture reduction quality,Ratliff score,Harris hip function score and complications were compared between the two groups.Results The closed reduction group had shorter operation time and less intraoperative blood loss than the open reduction group,while the open reduction group had better fracture reduction quality than the closed reduction group,the difference was statistically significant(P<0.05).There was no significant difference in the number of intraoperative fluoroscopy and hospital stay between the closed reduction group and the open reduction group(P>0.05).The postoperative follow-up time of closed reduction group was 24-47 months,with an average one of 32.7 months.The postoperative follow-up time of open reduction group was 24-55 months,with an average one of 35.4 months.There was no significant difference in fracture healing time,Ratliff score results at the last follow-up,and Harris hip function score at the last follow-up between the closed reduction group and the open reduction group(P>0.05).During the follow-up period,in the closed reduction group,5 patients developed avascular necrosis of the femoral head,1 developed coxa vara deformity,and 1 developed premature closure of the physis;In the open reduction group,avascular necrosis of the femoral head occurred in 3 cases and premature closure of the physis occurred in 1 case,but no coxa vara deformity occurred.Conclusion Both closed reduction and open reduction and internal fixation with cannulated screws are effective in the treatment of Delbet type Il and I femoral neck fractures in children.Early surgery does not reduce the risk of avascular necrosis of the femoral head.Clinicians should pay attention to relieving intracapsular hypertension during surgery.Failure if manipulative and pry reduction of fracture requires immediate open reduction to reduce complication rate.