儿童移位型股骨颈骨折应用空心螺钉与小儿髋部锁定加压接骨板治疗的优劣性比较
|
摘要
目的探讨空心螺钉及小儿髋部锁定加压接骨板(LCP-PHP)在儿童移位型股骨颈骨折治疗中的优劣。方法选取收治的46例移位型股骨颈骨折儿童,随机分为LCP组和空心螺钉组,每组23例。其中LCP组患儿给予切开复位LCP-PHP内固定治疗,空心螺钉组则将内固定物改为空心螺钉,观察2组手术时间、术中出血量、手术切口直径大小及2组术中平均损伤骨骺次数等术中情况;记录2组术后1 d及3 d的视觉疼痛模拟评分(VAS);观察2组术后骨性愈合时间及开始不负重康复训练时间;于2组术后1年采用Ratliff分级功能评分评估疗效,测定2组Harris髋关节功能评分及颈干角丢失度;记录2组术后1年内各项手术并发症发生例数。结果空心螺钉组在手术时间、切口直径、术中出血量及术后首日的VAS评分方面均显著低于LCP组(P<0.05);而平均术中损伤骨骺次数及术后3 d VAS 2组差异无统计学意义(P>0.05)。LCP组患儿无论是术后不负重下开始康复训练的时间、骨性愈合时间还是颈干角丢失度,均明显少于空心螺钉组;而Harris功能评分上则显著高于空心螺钉组(P<0.05)。空心螺钉组Ratliff分级优良率73.91%显著低于LCP组95.65%(P<0.05);但其术后并发症发生率30.43%与LCP组21.74%相比差异无统计学意义(P>0.05)。结论 LCP-PHP内固定对于患儿骨折后骨折端骨性解构及功能恢复有更加积极的作用,但其手术创伤较空心螺钉内固定大,两种内固定术各有优劣,需结合实际选择。
Objective Comparison of the therapeutic effects of cannulate screw and locking compression pediatric hip plate( LCP-PHP) on displaced femoral neck fractures in children. Methods Forty-six children patients with femoral neck fractures were randomly divided into two groups,the 23 patients in LCP group were treated by LCP-PHP,however,the other 23 patients in cannulate screw group were treated by cannulate screw internal fixation. The duration of surgery,intraoperative bleeding volume,diameter and size of surgical incision,frequency of epiphyseal injury and VAS score on 1 d,3 d after operation were observed and compared between two groups. Moreover the bone union time and the rehabilitation training time without weight-bearing after operation were also observed. In addition the therapeutic effects were evaluated by Ratliff hip joint function score,moreover,the Harris hip scores,the loss of collodiaphysial angle and incidence of postoperative complications were observed and compared between two groups. Results The duration of surgery,intraoperative bleeding volume,diameter and size of surgical incision and VAS scores on 1 d after operation in cannulate screw group were superior to those in LCP group( P < 0. 05),however,there was no significant difference in the frequency of epiphyseal injury between two groups( P >0. 05). The bone union time,the rehabilitation training time without weight-bearing after operation and the loss degree of collodiaphyseal angle in LCP group were significantly less than those in cannulate screw group,however,the Harris hip joint function scores in LCP group were significantly higher than those in cannulate screw group( P < 0. 05). In addition the excellent and good rate of Ratliff classification in hocannulate screw group was 73. 91%,which was significantly lower than that( 95. 65%) in LCP group( P < 0. 05),However there was no significant difference in incidence rate of postoperative complications between two groups( P > 0. 05). Conclusion LCP-PHP internal fixation has more active effects on function recovery of displaced femoral neck fractures in children,but its surgical trauma is more serious than that by cannulate screw internal fixation,and both internal fixation methods have advantages and disadvantages,therefor,which should be selected according to clinical practical status.
Objective Comparison of the therapeutic effects of cannulate screw and locking compression pediatric hip plate( LCP-PHP) on displaced femoral neck fractures in children. Methods Forty-six children patients with femoral neck fractures were randomly divided into two groups,the 23 patients in LCP group were treated by LCP-PHP,however,the other 23 patients in cannulate screw group were treated by cannulate screw internal fixation. The duration of surgery,intraoperative bleeding volume,diameter and size of surgical incision,frequency of epiphyseal injury and VAS score on 1 d,3 d after operation were observed and compared between two groups. Moreover the bone union time and the rehabilitation training time without weight-bearing after operation were also observed. In addition the therapeutic effects were evaluated by Ratliff hip joint function score,moreover,the Harris hip scores,the loss of collodiaphysial angle and incidence of postoperative complications were observed and compared between two groups. Results The duration of surgery,intraoperative bleeding volume,diameter and size of surgical incision and VAS scores on 1 d after operation in cannulate screw group were superior to those in LCP group( P < 0. 05),however,there was no significant difference in the frequency of epiphyseal injury between two groups( P >0. 05). The bone union time,the rehabilitation training time without weight-bearing after operation and the loss degree of collodiaphyseal angle in LCP group were significantly less than those in cannulate screw group,however,the Harris hip joint function scores in LCP group were significantly higher than those in cannulate screw group( P < 0. 05). In addition the excellent and good rate of Ratliff classification in hocannulate screw group was 73. 91%,which was significantly lower than that( 95. 65%) in LCP group( P < 0. 05),However there was no significant difference in incidence rate of postoperative complications between two groups( P > 0. 05). Conclusion LCP-PHP internal fixation has more active effects on function recovery of displaced femoral neck fractures in children,but its surgical trauma is more serious than that by cannulate screw internal fixation,and both internal fixation methods have advantages and disadvantages,therefor,which should be selected according to clinical practical status.
引文
1张彦,鲍琨,陈博昌.儿童股骨颈骨折延迟固定治疗与并发症相关性的探讨.中华小儿外科杂志,2013,34:515-518.
2 向柄彦,王兴旭,徐林.切开复位空心螺钉固定治疗移位型儿童股骨颈骨折.贵州医药,2013,37:722-724.
3 Ju L,Jiang B,Lou Y,et al.Delayed treatment of femoral neck fractures in 58 children:open reduction internal fixation versus closed reduction internal fixation.Pediatr Orthop B,2016,25:459-465.
4 陈顺有,梅海波,郭跃明,等.儿童髋部锁定加压接骨板和空心钉治疗儿童股骨颈骨折(DelbetⅡ、Ⅲ型)的比较研究.中华小儿外科杂志,2016,37:898-902.
5 王波,楼跃,唐凯,等.空心螺钉与小儿髋部锁定加压接骨板治疗儿童移位型股骨颈骨折的疗效比较.中华创伤骨科杂志,2016,18:662-667.
6 谢华杰,孔繁杰,覃奇文,等.闭合复位PFNA内固定治疗股骨粗隆间骨折20例疗效观察.海南医学,2014,25:2287-2288.
7 孙欣,曾荣,胡资兵,等.空心螺钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析.中华创伤骨科杂志,2012,14:477-479.
8 李立,赵国强,朱建.小儿髋部锁定加压接骨板治疗儿童股骨粗隆部骨折.中华小儿外壳,2013,34:474-476.
9 Li H,Zhao L,Huang LY,et al.Delayed slipped capital femoral epiphy-sis after treatment of femoral neck fracture in children I.Clin Orthop Relat Res,2015,473:2712-2717.
10 蒲涛,谭小云,胡行志.闭合复位空心螺钉内固定治疗股骨颈骨折252 例疗效观察.海军医学杂志,2013,34:375-377.
11 Thein R,Herman A,Kedem P,et al.Osteosynthesis of unstable intracapsular femoral neck fracture by dynamic locking plate or screw fixation:early results.Orthop Trauma,2014,28:70-76.
12 Sidler-Maier CC,Reidy K,Huber H,et al.LCP 140 pediatric hip platefor fixation of proximal femoral valgisation osteotomy.J Child0 rthop,2014,8:29-35.
13 Yuenyongviwat V,Tuntarattanapong P,Tangtrakulwanieh B.A new adjustable parallel drill guide for internal fixation of femoral neck fracture:a developmental and experimental study.BMC Musculoskelet Disord,2016,17:8.
14 尤瑞金,杨德育,黄飞,等.120°儿童髋锁定加压钢板治疗儿童股骨转子下骨折.中国矫形外科杂志,2016,24:1072-1075.
15 Islam SU,Henry A,Khan T,et al.The OUt COlne of paediatric LCP hipplate use in childrenⅥith and without neuromuscular disease.Museulaskelet Surg,2014,98:233-239.
16 Stone JD,Hill MK,Pan Z,et al.Open reduction of pediatric femora neck fractures reduces osteonecrosis risk.Orthopedics,2015,38:e983-e990.
17 Spence D,Di Mauro JP,Miller PE,et al.Osteonecrosis after femoral neck fractures in c Kldren and adolescents:analysis of risk factors.J Pediatr Orthop,2016,36:111-116.
18 Kuo FC,Kuo s J,Ko JY.Overgrowth of the femoral neck after hip fractures in children.J Orthop Surg Res,2016,11:50.
19 郑朋飞,徐鹏,陈杰,等.个体化数字导航模板引导儿童髋部置入的应用.中华小儿外科杂志,2016,37:779-784.
20 郑朋飞,楼跃,徐鹏,等.3D打印个体化手术导航模板引导儿童股骨颈骨折空心螺钉置入的应用.中国数字医学,2016,11:14-17.
21 王波,楼跃,唐凯,等.改良Watson-Jones人路联合小儿髋部锁定加压接骨板治疗股骨颈骨折.中华实用儿科临床杂志,2016,31:829-832.
22 郑朋飞,唐凯,王黎明,等.3D打印个体化手术导航模板在儿童股骨颈骨折中的应用.中华实用儿科临床杂志,2016,31:863-866.
2 向柄彦,王兴旭,徐林.切开复位空心螺钉固定治疗移位型儿童股骨颈骨折.贵州医药,2013,37:722-724.
3 Ju L,Jiang B,Lou Y,et al.Delayed treatment of femoral neck fractures in 58 children:open reduction internal fixation versus closed reduction internal fixation.Pediatr Orthop B,2016,25:459-465.
4 陈顺有,梅海波,郭跃明,等.儿童髋部锁定加压接骨板和空心钉治疗儿童股骨颈骨折(DelbetⅡ、Ⅲ型)的比较研究.中华小儿外科杂志,2016,37:898-902.
5 王波,楼跃,唐凯,等.空心螺钉与小儿髋部锁定加压接骨板治疗儿童移位型股骨颈骨折的疗效比较.中华创伤骨科杂志,2016,18:662-667.
6 谢华杰,孔繁杰,覃奇文,等.闭合复位PFNA内固定治疗股骨粗隆间骨折20例疗效观察.海南医学,2014,25:2287-2288.
7 孙欣,曾荣,胡资兵,等.空心螺钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析.中华创伤骨科杂志,2012,14:477-479.
8 李立,赵国强,朱建.小儿髋部锁定加压接骨板治疗儿童股骨粗隆部骨折.中华小儿外壳,2013,34:474-476.
9 Li H,Zhao L,Huang LY,et al.Delayed slipped capital femoral epiphy-sis after treatment of femoral neck fracture in children I.Clin Orthop Relat Res,2015,473:2712-2717.
10 蒲涛,谭小云,胡行志.闭合复位空心螺钉内固定治疗股骨颈骨折252 例疗效观察.海军医学杂志,2013,34:375-377.
11 Thein R,Herman A,Kedem P,et al.Osteosynthesis of unstable intracapsular femoral neck fracture by dynamic locking plate or screw fixation:early results.Orthop Trauma,2014,28:70-76.
12 Sidler-Maier CC,Reidy K,Huber H,et al.LCP 140 pediatric hip platefor fixation of proximal femoral valgisation osteotomy.J Child0 rthop,2014,8:29-35.
13 Yuenyongviwat V,Tuntarattanapong P,Tangtrakulwanieh B.A new adjustable parallel drill guide for internal fixation of femoral neck fracture:a developmental and experimental study.BMC Musculoskelet Disord,2016,17:8.
14 尤瑞金,杨德育,黄飞,等.120°儿童髋锁定加压钢板治疗儿童股骨转子下骨折.中国矫形外科杂志,2016,24:1072-1075.
15 Islam SU,Henry A,Khan T,et al.The OUt COlne of paediatric LCP hipplate use in childrenⅥith and without neuromuscular disease.Museulaskelet Surg,2014,98:233-239.
16 Stone JD,Hill MK,Pan Z,et al.Open reduction of pediatric femora neck fractures reduces osteonecrosis risk.Orthopedics,2015,38:e983-e990.
17 Spence D,Di Mauro JP,Miller PE,et al.Osteonecrosis after femoral neck fractures in c Kldren and adolescents:analysis of risk factors.J Pediatr Orthop,2016,36:111-116.
18 Kuo FC,Kuo s J,Ko JY.Overgrowth of the femoral neck after hip fractures in children.J Orthop Surg Res,2016,11:50.
19 郑朋飞,徐鹏,陈杰,等.个体化数字导航模板引导儿童髋部置入的应用.中华小儿外科杂志,2016,37:779-784.
20 郑朋飞,楼跃,徐鹏,等.3D打印个体化手术导航模板引导儿童股骨颈骨折空心螺钉置入的应用.中国数字医学,2016,11:14-17.
21 王波,楼跃,唐凯,等.改良Watson-Jones人路联合小儿髋部锁定加压接骨板治疗股骨颈骨折.中华实用儿科临床杂志,2016,31:829-832.
22 郑朋飞,唐凯,王黎明,等.3D打印个体化手术导航模板在儿童股骨颈骨折中的应用.中华实用儿科临床杂志,2016,31:863-866.