弹性髓内钉联合早期石膏固定治疗肥胖儿童下肢长骨干骨折的疗效
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摘要
目的探讨弹性髓内钉(ESIN)联合早期石膏固定治疗肥胖儿童下肢长骨干骨折的临床疗效。方法回顾性分析35例下肢长骨干骨折肥胖患儿的临床资料,均采用微创闭合复位ESIN联合早期石膏固定治疗。观察患儿住院时间、骨折愈合情况、术后并发症及不良事件发生情况,术后半年根据ESIN治疗长骨骨折的评分标准及长骨干骨折的放射学愈合标准评价其疗效。结果所有患儿均顺利完成手术,住院时间为(4. 68±1. 32) d。术后均未出现下肢畸形愈合,无不良事件发生; 2例患者出现皮肤激惹反应; 1例骨折愈合时间延长。术后半年根据长骨干愈合放射学标准,1分级9例、2分级24例、3分级2例;根据ESIN疗效评分标准,优31例、良4例,优良率为100%。结论 ESIN联合早期石膏固定治疗肥胖儿童下肢长骨干骨折疗效确切,住院周期短,并发症少。
Objective To explore the clinical efficacy of elastic stable intramedullary nailing( ESIN combined with early plaster fixation for long bone shaft fracture of lower limbs in obese children. Methods The clinical data of 35 obese children with long bone shaft fracture of lower limbs were retrospectively analyzed,all of them were treated with minimally invasive closed reduction ESIN combined with early plaster fixation. Hospital stay,fracture healing,postoperative complications and incidence of adverse events were observed among the children,six months after operation,the efficacy was evaluated according to the ESIN score criteria for long bone fracture and the radiological criteria for long bone shaft fracture healing. Results All children completed the operation successfully,with a hospital stay of 4. 68 ± 1. 32 days. After operation,neither malunion of lower limbs nor adverse events occurred; 2 cases experienced skin irritation,1 case reported prolonged duration for fracture healing. Six months after operation,according to the radiological criteria for long bone shaft healing,9 cases were classified as grade 1,24 cases as grade 2,2 cases as grade 3; according to the ESIN score criteria for efficacy,31 cases scored excellent and 4 cases scored good,with an excellent and good rate of 100%. Conclusion ESIN combined with early plaster fixation has definite efficacy,decreased hospital stay and fewer complications for the treatment of long bone shaft fracture of lower limbs in obese children.
Objective To explore the clinical efficacy of elastic stable intramedullary nailing( ESIN combined with early plaster fixation for long bone shaft fracture of lower limbs in obese children. Methods The clinical data of 35 obese children with long bone shaft fracture of lower limbs were retrospectively analyzed,all of them were treated with minimally invasive closed reduction ESIN combined with early plaster fixation. Hospital stay,fracture healing,postoperative complications and incidence of adverse events were observed among the children,six months after operation,the efficacy was evaluated according to the ESIN score criteria for long bone fracture and the radiological criteria for long bone shaft fracture healing. Results All children completed the operation successfully,with a hospital stay of 4. 68 ± 1. 32 days. After operation,neither malunion of lower limbs nor adverse events occurred; 2 cases experienced skin irritation,1 case reported prolonged duration for fracture healing. Six months after operation,according to the radiological criteria for long bone shaft healing,9 cases were classified as grade 1,24 cases as grade 2,2 cases as grade 3; according to the ESIN score criteria for efficacy,31 cases scored excellent and 4 cases scored good,with an excellent and good rate of 100%. Conclusion ESIN combined with early plaster fixation has definite efficacy,decreased hospital stay and fewer complications for the treatment of long bone shaft fracture of lower limbs in obese children.
引文
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[13] Hunter JB. The principles of elastic stable intramedullary nailing in children[J]. Injury,2005,36(Suppl 1):A20-A24.
[14]姚琦,唐佩福,黄鹏,等.股骨骨折闭合复位髓内固定后骨折端旋转移位的CT测量[J].中国矫形外科杂志,2007,15(4):260-262.
[15] Salem KH,Keppler P. Limb geometry after elastic stable nailing for pediatric femoral fractures[J]. J Bone Joint Surg Am,2010,92(6):1 409-1 417.
[16] Valaikaite R,Salvo D,Ceroni D. Patient positioning on the operative table for more accurate reduction during elastic stable intramedullary nailing of the femur:a technical note[J]. J Bone Joint Surg Am,2015,97(8):695-698.
[17]顾章平,于向华,李浩宇,等.钛制弹性髓内针治疗儿童胫骨骨折[J].临床小儿外科杂志,2006,5(2):98-99,125.
[18]陈伟,李佳,张英泽. AAOS《儿童股骨干骨折治疗指南》解读[J].中华外科杂志,2017,55(1):44-48.
[19] Jevsevar DS,Shea KG,Murray JN,et al. AAOS clinical practice guideline on the treatment of pediatric diaphyseal femur fractures[J]. J Am Acad Orthop Surg,2015,23(12):e101.
[2]张英泽.临床创伤骨科流行病学[M]. 2版.北京:人民卫生出版社,2014:1-13.
[3] Beaty JH,Kasser JR,Skaggs DL,等.洛克伍德-威尔金斯儿童骨折[M].黄耀添,颉强,赵黎,等译. 7版.北京:人民军医出版社,2014:10.
[4]张世民,李海丰,黄轶刚.骨折分类与功能评定[M].北京:人民军医出版社,2008:13-14.
[5]宗心南,李辉.中国儿童身高与体重的生长模式及简单数学模型的建立[J].中华儿科杂志,2009,47(5):371-375.
[6] Parikh SN,Nathan ST,Priola MJ,et al. Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures[J].Clin Orthop Relat Res,2014,472(9):2 735-2 744.
[7] Hammer RR,Hammerby S,Lindholm B. Accuracy of radiologic assessment of tibial shaft fracture union in humans[J].Clin Orthop Relat Res,1985,(199):233-238.
[8] Counselman FL. Pediatric fractures:a practical approach[J].Emergency Med,1993,13(2):274-275.
[9] Talbot C,Davis N,Majid I,et al. Fractures of the femoral shaft in children:national epidemiology and treatment trends in England following activation of major trauma networks[J]. Bone Joint J,2018,100-B(1):109-118.
[10] Wright JG,Wang EE,Owen JL,et al. Treatments for paediatric femoral fractures:a randomised trial[J]. Lancet,2005,365(9 465):1 153-1 158.
[11] Moroz LA,Launay F,Kocher MS,et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome[J]. J Bone Joint Surg Br,2006,88(10):1 361-1 366.
[12] Canavese F,Marengo L,Andreacchio A,et al. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms(one hundred and ten pounds)and more[J]. Int Orthop,2016,40(12):2 627-2 634.
[13] Hunter JB. The principles of elastic stable intramedullary nailing in children[J]. Injury,2005,36(Suppl 1):A20-A24.
[14]姚琦,唐佩福,黄鹏,等.股骨骨折闭合复位髓内固定后骨折端旋转移位的CT测量[J].中国矫形外科杂志,2007,15(4):260-262.
[15] Salem KH,Keppler P. Limb geometry after elastic stable nailing for pediatric femoral fractures[J]. J Bone Joint Surg Am,2010,92(6):1 409-1 417.
[16] Valaikaite R,Salvo D,Ceroni D. Patient positioning on the operative table for more accurate reduction during elastic stable intramedullary nailing of the femur:a technical note[J]. J Bone Joint Surg Am,2015,97(8):695-698.
[17]顾章平,于向华,李浩宇,等.钛制弹性髓内针治疗儿童胫骨骨折[J].临床小儿外科杂志,2006,5(2):98-99,125.
[18]陈伟,李佳,张英泽. AAOS《儿童股骨干骨折治疗指南》解读[J].中华外科杂志,2017,55(1):44-48.
[19] Jevsevar DS,Shea KG,Murray JN,et al. AAOS clinical practice guideline on the treatment of pediatric diaphyseal femur fractures[J]. J Am Acad Orthop Surg,2015,23(12):e101.