经皮撬拔复位钛弹性髓内钉治疗儿童不稳定型股骨转子下骨折
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摘要
目的:探讨经皮克氏针撬拔复位钛弹性髓内钉内固定治疗儿童不稳定型股骨转子下骨折的临床疗效。方法:选择2014年1月—2016年12月某院收治的16例不稳定型股骨转子下骨折患儿,其中男10例,女6例,年龄4～11(5.4±1.8)岁。患者入院后即予以患肢皮牵引制动。受伤至手术时间为1～6(3.5±1.9)天。所有患儿的手术方案均为经皮克氏针撬拔复位钛弹性髓内钉内固定。结果:术后所有患儿切口均一期愈合,无脂肪液化、切口皮缘坏死、感染及血管神经损伤等并发症发生。16例患儿获得18～30(23.4±2.9)个月随访。患儿均获得骨性愈合,愈合时间12～20(14.8±2.2)周,随访期间无钉尾皮肤激惹、股骨头坏死、骨骺早闭、髓内钉变形折断、肢体短缩或过度生长、再骨折等并发症发生。患儿均有不同程度的向前成角,3～8°(5.3±1.7)°,所有患儿均无内外翻成角。末次随访时Harris髋关节功能评分为86～97(92.6±3.0)分,优良率100%。结论:采用经皮克氏针撬拔复位钛弹性髓内钉内固定治疗儿童不稳定型股骨转子下骨折是一种安全有效的手术方法,其并发症少,风险小,临床疗效满意。
Objective:To discuss the clinical efficacy of percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation in treatment of unstable femoral subtrochanteric fractures in children.Methods:16 cases of unstable femoral subtrochanteric fractures treated in a hospital from January 2014 to December 2016 were selected, including 10 males, 6 females, aged 4 to 11 years, with an average age of(5.4±1.8) years. All the cases were given skin and limb traction braking. The time from injury to surgery was 1 to 6 days, with an average of(3.5±1.9) days. The surgical method used was percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation.Results:All incisions after the operation were primary healing, with no complications occurring such as fat liquefaction, incision skin edge necrosis, infection or injury of blood vessel. The 16 patients were followed up for 18 to 30 months, with an average of(23.4±2.9) months. All of them acquired bone union, the union time being 12 to 20 weeks, with an average of(14.8±2.2) weeks. During the follow-up, no complications such as skin irritation of nail end, femoral head necrosis, early closure of epiphyseal, deformation or fracture of intramedullary nail, limb shortening or overgrowth, and re-fracture occurred. All the patients had different degrees of anterior angulation, ranging from 3 to 8°, with an average of(5.3±1.7)°. All the patients had no varus and valgus angulation. At the last follow-up, the Harris hip joint function score was 86～97 points, with an average of(92.6±3.0) points and good rate of 100%.Conclusion:Percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation is a safe and effective surgical method with fewer complications, less risk and more satisfactory clinical efficacy.
Objective:To discuss the clinical efficacy of percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation in treatment of unstable femoral subtrochanteric fractures in children.Methods:16 cases of unstable femoral subtrochanteric fractures treated in a hospital from January 2014 to December 2016 were selected, including 10 males, 6 females, aged 4 to 11 years, with an average age of(5.4±1.8) years. All the cases were given skin and limb traction braking. The time from injury to surgery was 1 to 6 days, with an average of(3.5±1.9) days. The surgical method used was percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation.Results:All incisions after the operation were primary healing, with no complications occurring such as fat liquefaction, incision skin edge necrosis, infection or injury of blood vessel. The 16 patients were followed up for 18 to 30 months, with an average of(23.4±2.9) months. All of them acquired bone union, the union time being 12 to 20 weeks, with an average of(14.8±2.2) weeks. During the follow-up, no complications such as skin irritation of nail end, femoral head necrosis, early closure of epiphyseal, deformation or fracture of intramedullary nail, limb shortening or overgrowth, and re-fracture occurred. All the patients had different degrees of anterior angulation, ranging from 3 to 8°, with an average of(5.3±1.7)°. All the patients had no varus and valgus angulation. At the last follow-up, the Harris hip joint function score was 86～97 points, with an average of(92.6±3.0) points and good rate of 100%.Conclusion:Percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation is a safe and effective surgical method with fewer complications, less risk and more satisfactory clinical efficacy.
引文
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[11] XU Y,BIAN J,SHEN K,et al.Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures[J].Medicine (Baltimore),2018,97(29):e11568.
[12] 黎健伟,吴建群,孟欢,等.低切迹多向锁定钢板系统固定治疗学龄前儿童股骨转子下骨折[J].中华创伤骨科杂志,2017,19(8):691-695.
[13] GOGNA P,MOHINDRA M,VERMA S,et al.Adult proximal humerus locking plate for fixation of paediatric subtrochanteric fractures[J].Musculoskelet Surg,2014,98(3):189-194.
[14] HERRERA-SOTO JA,MEURET R,PHILLIPS JH,et al.The ma-nagement of pediatric subtrochanteric femur fractures with a statically locked intramedullary nail[J].J Orthop Trauma,2015,29(1):e7-e11.
[15] LI Y,HEYWORTH BE,GLOTZBECKER M,et al.Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures[J].J Pediatr Orthop,2013,33(3):232-238.
[16] 吴敏,官建中,陈笑天,等.经皮闭合复位弹性髓内钉固定治疗儿童股骨转子下骨折[J].中国矫形外科杂志,2016,24(10):874-878.
[2] JENG C,SPONSELLER PD,YATES A,et al.Subtrochanteric femoral fractures in children.Alignment after 90 degrees-90 degrees traction and cast application[J].Clin Orthop Relat Res,1997(341):170-174.
[3] 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):2735-2744.
[4] POMBO MW,SHILT JS.The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails[J].J Pediatr Orthop,2006,26(3):364-370.
[5] 王岩,译.坎贝尔骨科手术学[M].12版.北京:人民军医出版社,2013:1354.
[6] CORTES LE,TRIANA M,VALLEJO F,et al.Adult proximal humerus locking plate for the treatment of a pediatric subtrochanteric femoral nonunion:a case report[J].J Orthop Trauma,2011,25(7):e63-7.
[7] 宋宝健,王强,冯伟,等.外固定架治疗儿童股骨转子下骨折[J].临床小儿外科杂志,2016,15(1):63-65.
[8] JARVIS J,DAVIDSON D,LETTA M.Management of subtrochanteric fractures in skeletally immature adolescents[J].J Trauma,2006,60(3):613-619.
[9] 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[J].中国矫形外科杂志,2016,24(12):1072-1075.
[10] 左玉明,于铁强,王月光,等.儿童髋部锁定加压钢板固定治疗学龄儿童股骨转子下骨折[J].中国矫形外科杂志,2016,24(4):310-313.
[11] XU Y,BIAN J,SHEN K,et al.Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures[J].Medicine (Baltimore),2018,97(29):e11568.
[12] 黎健伟,吴建群,孟欢,等.低切迹多向锁定钢板系统固定治疗学龄前儿童股骨转子下骨折[J].中华创伤骨科杂志,2017,19(8):691-695.
[13] GOGNA P,MOHINDRA M,VERMA S,et al.Adult proximal humerus locking plate for fixation of paediatric subtrochanteric fractures[J].Musculoskelet Surg,2014,98(3):189-194.
[14] HERRERA-SOTO JA,MEURET R,PHILLIPS JH,et al.The ma-nagement of pediatric subtrochanteric femur fractures with a statically locked intramedullary nail[J].J Orthop Trauma,2015,29(1):e7-e11.
[15] LI Y,HEYWORTH BE,GLOTZBECKER M,et al.Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures[J].J Pediatr Orthop,2013,33(3):232-238.
[16] 吴敏,官建中,陈笑天,等.经皮闭合复位弹性髓内钉固定治疗儿童股骨转子下骨折[J].中国矫形外科杂志,2016,24(10):874-878.