外翻截骨治疗儿童Pauwels III型陈旧性股骨颈骨折

Valgus osteotomy for Pauwels type III old femoral neck fracture in children

摘要:

[目的]评价外翻截骨治疗儿童陈旧性股骨颈骨折疗效分析。[方法]2016—2021 年对 4 例 Pauwels III 型陈旧性股骨颈骨折的患者行股骨外翻截骨、 LCP-PHP 固定。总结临床与影像资料。[结果]4 例患者均顺利完成手术，手术时间(161.25± 51.05)min，切口长度(10.75±2.98)cm，术中失血量(192.50±86.94)ml。切口均一期愈合。所有患者术后髋人字石膏固定 6 周。石膏拆除后 1 个月患肢不负重下地活动，3 个月后恢复完全负重活动。所有患者均获随访 9~23 个月，平均 (18.50±6.45) 个月。随访过程中，患者均无再损伤，无翻修手术。与术前相比，末次随访时，患者的 VAS 评分显著下降(P＜0.05)，而 Har- ris 评分，髋关节屈伸 ROM 显著增加(P＜0.05)。4 例患者均行走正常，无明显跛行，下蹲活动正常，均恢复日常生活和运动能力。[结论]外翻截骨是治疗陈旧性股骨颈骨折的一种有效的治疗方式。

Abstract:

[Objective] To evaluate the efficacy of valgus osteotomy for the treatment of Pauwels type III old femoral neck fracture in children. [Methods] From 2016 to 2021, 4 patients with Pauwels TYPE III old femoral neck fracture were treated with valgus osteotomy of proximal femur with internal fixation by locking compression pediatric hip plate (LCP-PHP) . The clinical and imaging documents were summarized. [Results] All the 4 patients were successfully operated on with operation time of (161.25 ± 51.05) min, incision length of (10.75±2.98) cm, intraoperative blood loss of (192.50±86.94) ml, and primary healing of the incision. All patients had unilateral spica cast as external fixation for 6 weeks after surgery. The patients resumed actively affected limb motion without weight bearing one month after the cast removed, and then full weight-bearing activity 3 months later. All the patients were followed up for 9~23 months, with an average of (18.50±6.45) months. During the follow-up, there was no reinjury or revision surgery in anyone of them. The VAS score significantly de- creased (P＜0.05) , while Harris score and hip flexion-extension range of motion (ROM) significantly increased at the latest follow up com- pared with those preoperatively (P＜0.05) . At the latest follow up, all the 4 patients recovered normal walking without obvious claudication, whereas with normal squatting activities, and resumed normal daily life activity and sports capacity. [Conclusion] Valgus osteotomy is an ef- fective treatment for old femoral neck fracture in children.