闭合复位2枚与3枚弹性髓内钉内固定治疗儿童股骨粗隆下骨折的疗效比较

Comparison of efficacy of closed reduction and the use of two or three elastic intramedullary nail internal fixation in treatment of femoral subtrochanteric fractures in children

目的比较采用闭合复位2枚与3枚弹性髓内钉内固定治疗儿童股骨粗隆下骨折的临床疗效。方法纳入自2018-01—2022-01采用闭合复位弹性髓内钉内固定治疗的55例儿童股骨粗隆下骨折,其中A组28例采用2枚弹性髓内钉内固定,B组27例采用3枚弹性髓内钉内固定。比较两组手术时间、术中出血量、术后至开始下床活动时间、术后骨折端成角情况、骨折愈合时间,以及末次随访时髋关节各方向活动度、双下肢长度差值、股骨颈干角、Flynn功能评分。结果55例均获得随访,随访时间为12~18个月,平均15.4个月。所有患儿均未出现切口感染、髓内钉退出、髓内钉断裂、骨折不愈合等并发症。A组1例骨折畸形愈合(成角>5°),但是末次随访时成角<10°;1例术后患侧下肢长度较健侧短缩1 cm,末次随访时长度差在2 cm内。B组出现2例钉道处皮肤激惹,对症治疗后症状消失。B组手术时间较A组长,术中出血量较A组多,但是术后至开始下床活动时间、骨折愈合时间较A组短,差异有统计学意义(P<0.05)。A组与B组术后骨折端成角、股骨颈干角、双下肢长度差值差异无统计学意义(P>0.05)。A组与B组末次随访时髋关节各方向活动度、Flynn功能评定结果差异无统计学意义(P>0.05)。结论闭合复位弹性髓内钉内固定是治疗儿童股骨粗隆下骨折的有效手术方法,与2枚弹性髓内钉内固定患儿相比,3枚弹性髓内钉内固定患儿可以更早进行负重活动,并且骨折愈合时间更短。

Objective To compare the clinical efficacy of closed reduction and the use of two or three elastic intramedullary nails for the treatment of femoral subtrochanteric fractures in children.Methods Fifty-five children with femoral subtrochan⁃teric fractures were treated with closed reduction and elastic intramedullary nail fixation from January 2018 to January 2022 were included.Among them,28 cases in group A were fixed with two elastic intramedullary nails while 27 cases in group B were fixed with three elastic intramedullary nails.The surgical time,intraoperative blood loss,postoperative time to mobiliza⁃tion,postoperative fracture end angulation,fracture healing time,as well as hip joint range of motion in all directions,differ⁃ence in length between the two lower limbs,femoral neck shaft angle,and Flynn functional score at the last follow-up were compared between the two groups.Results All cases were followed up for 12-18 months,with an average of 15.4 months.All patients did not experience complications such as incision infection,intramedullary nail withdrawal,intramedullary nail frac⁃ture,or non-union of fractures.One case had fracture malunion(angle>5°)in group A,but the angle<10°at the last follow-up.One case had a shortened lower limb length of 1 cm on the affected side compared to the healthy side after surgery,and the length difference was within 2 cm at the last follow-up.Two cases of skin irritation occurred at the nail site in group B,and symptomatic treatment was given.The operation time of group B was longer than that of group A,and the intraoperative blood loss was greater than that of group A.However,the time to start mobilization after surgery and fracture healing time were shorter than those of group A,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the angle of fracture end,femoral neck shaft angle,and length discrepancy of both lower limbs between group A and group B af⁃ter surgery(P>0.05).There was no statistically significant difference in hip joint range of motion and Flynn function assessment results between group A and group B at the last follow-up(P>0.05).Conclusion Closed reduction and elastic intramedullary nail fixation is an effective surgical method for treating femoral subtrochanteric fractures in children.Compared with two elastic intramedullary nails fixation,three elastic intramedullary nails fixation can enable children to engage in weight-bearing activities earlier and have a shorter fracture healing time.