弹性髓内钉与钢板治疗大龄儿童股骨转子下骨折

Elastic stable intramedullary nail versus proximal femoral locking compression plate for femoral subtrochanteric fracture in old children

摘要:

[目的] 对比弹性髓内钉与股骨近端锁定加压钢板治疗大龄儿童股骨转子下骨折的临床疗效。[方法] 回顾性分析 2013 年 1 月—2018 年 1 月本院手术治疗儿童股骨转子下骨折 33 例患者的临床资料。根据骨折类型和器械适应证，18 例采用髓内钉固定，15 例采用钢板固定。比较两组患儿围手术期、随访与影像资料。[结果] 两组均顺利完成手术。髓内钉组手术时间、术中出血量、切口长度、住院天数均显著优于钢板组(P＜0.05)，但前者术中透视次数显著多于后者(P＜0.05)。两组患儿术后均获随访 18 个月以上。两组下地行走时间及完全负重时间的差异均无统计学意义(P＞0.05)。随术后时间推移，两组患者 ROM 和 Harris 评分均显著增加 (P＜0.05)。术后相应时间点，髓内钉组 ROM 及 Harris 评分均高于钢板组，但差异均无统计学意义(P＞0.05)。影像方面，按改良的 Baumgaertner 标准，髓内钉组骨折复位质量显著不及钢板组(P＜0.05)，但是，髓内钉组骨折愈合时间显著早于钢板组(P＜0.05)。[结论]弹性髓内钉及股骨近端锁定加压钢板治疗大龄儿童股骨转子下骨折均可取得良好临床疗效，内固定方式可根据各自适应证进行选择。

Abstract:

[Objective] To compare the clinical efficacy of elastic stable intramedullary nail (ESIN) versus proximal femoral locking compression plate (PFLCP) for femoral subtrochanteric fracture in old children. [Methods] A retrospective study was conducted on 33 old children who received surgical treatment for femoral subtrochanteric fractures in our hospital from January 2013 to January 2018. Based on the fracture type and instrument indication, 18 patients underwent ESIN, while the other 15 patients had fractures fixed with PFLCP. The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups had operation performed smoothly. The ESIN group proved significantly superior to the PFLCP group in terms of operation time, intraoperative bleeding, incision length, and hospital days (P＜0.05) , although the former had significantly greater intraoperative fluo- roscopic frequency than the latter (P＜0.05) . The postoperative follow-up lasted for more than 18 months in the two groups. There were no significant differences in the time to return walking and the time to resume full-weight bearing activity between the two groups (P＞0.05) . Both the hip extension-flexion range of motion (ROM) and Harris score significantly increased over time postoperatively in both groups (P＜ 0.05) . The ESIN group was superior to the PFLCP group in terms of ROM and Harris score postoperatively, whereas which proved not sta- tistically significant at any matching time point (P＞0.05) . Regarding to radiographic assessment, the ESIN group was significantly inferior to the PFLCP group in term of fracture reduction quality based on Baumgaertner criteria (P＜0.05) , however, the ESIN group got fracture healing significantly earlier than the PFLCP group (P＜0.05) . [Conclusions] Both ESIN and PFLCP are effective for internal fixation of fem- oral subtrochanteric fractures in old children, which should be selected according to patient's concreate condition and the instrument indica- tions.