弹性与锁定髓内钉固定儿童青少年股骨干骨折比较

Elastic and locking intramedullary nail fixations for femoral shaft fractures in children and adolescents

摘要:

[目的] 比较弹性髓内钉（elastic stable intramedullary nailing, ESIN） 和锁定髓内钉（locked intramedullary nail, LIN）固定治疗儿童和青少年股骨干骨折的临床疗效。[方法] 回顾性分析2017 年1 月—2023 年7 月手术治疗的38 例股骨干移位骨折患者的临床资料，根据术前医患沟通结果，29 例采用ESIN（弹性组），9 例采用LIN（锁定组）。比较两组围手术期、随访和影像学结果。[结果] 弹性组手术时间[(103.8±37.4) min vs (188.3±28.5) min, P＜0.001]、切口总长度[(3.0±0.6) cm vs (6.4±0.7) cm,P＜0.001]、术中失血量[(33.6±26.7) ml vs (145.6±45.3) ml, P＜0.001]、术中透视次数[(6.5±1.2) 次vs (12.9±1.3) 次, P＜0.001]、住院时间[(7.3±2.3) d vs (11.9±1.3) d, P＜0.001] 均显著优于锁定组。随访时间均＞12 个月，弹性组的下地行走时间[(44.1±5.7) d vs (67.7±10.2) d, P＜0.001]、完全负重活动时间[(84.8±10.3) d vs (102.8±21.5) d, P=0.038] 均显著早于锁定组。与术后3 个月相比，末次随访两组Harris 评分、髋伸-屈ROM、HSS 评分、膝伸-屈ROM 均显著增加（P＜0.05），术后3 个月弹性组的髋伸-屈ROM[(110.5±4.2)° vs (100.6±3.0)°, P＜0.001] 显著优于锁定组，术后3 个月及末次随访时，锁定组的HSS 评分[(84.1±1.7) vs (74.4±4.2),P＜0.001; (94.4±0.9) vs (92.5±1.8), P=0.005]、膝伸-屈ROM [(114.4±3.9)° vs (71.4±4.6)°, P＜0.001; (125.0±3.5)° vs (106.2±3.4)°, P＜0.001] 显著优于弹性组。影像方面。两组术后股骨力线、股骨长度差、股骨颈干角均显著改善（P＜0.05），术前及末次随访时，弹性组的股骨颈干角均大于锁定组（P＜0.05)。[结论] 对相对稳定性股骨骨折采用ESIN 治疗简单、安全，功能恢复好。然而，对于相对不稳定骨折，可以考虑采用LIN 固定。

Abstract:

[Objective] To compare the clinical efficacy of elastic stable intramedullary nailing (ESIN) and locking intramedullary nail(LIN) for femoral shaft fractures in children and adolescents. [Methods] A retrospective study was conducted on 38 patients who receivedsurgical treatment for femoral shaft fractures from January 2017 to July 2023. According to preoperative doctor-patient communication, 29cases were treated with ESIN, while 9 cases were treated with LIN. The perioperative, follow-up and imaging results were compared be-tween the two groups. [Results] The ESIN proved significantly superior to the LIN in terms of operating time [(103.8±37.4) min vs (188.3±28.5) min, P＜0.001], total incision length [(3.0±0.6) cm vs (6.4±0.7) cm, P＜0.001], intraoperative blood loss [(33.6±26.7) ml vs (145.6±45.3) ml, P＜0.001], intraoperative fluoroscopy times [(6.5±1.2) times vs (12.9±1.3) times, P＜0.001] and hospital stay [(7.3±2.3) days vs(11.9±1.3) days, P＜0.001]. The follow-up time was ＞12 months, and the ESIN cohort resumed walking [(44.1±5.7) days vs (67.7±10.2)days, P＜0.001] and full weight-bearing activity time [(84.8±10.3) days vs (102.8±21.5) days, P=0.038] significantly earlier than the LIN co-hort. Compared with those 3 months after surgery, Harris score, hip extension-flexion ROM, HSS score and knee extension-flexion ROMwere significantly increased in both groups at the last follow-up (P＜0.05). The ESIN proved significantly better than the LIN regarding tohip extension-flexion ROM [(110.5±4.2)° vs (100.6±3.0)°, P＜0.001] 3 months postoperatively, as well as HSS score [(84.1±1.7) vs (74.4±4.2), P＜0.001; (94.4±0.9) vs (92.5±1.8), P=0.005], knee extension-flexion ROM [(114.4±3.9)° vs (71.4±4.6)°, P＜0.001; (125.0±3.5)° vs(106.2±3.4)°, P＜0.001] 3 months after operation and at the latest follow-up. As for images, the femoral alignment, femoral bilateral lengthdiscrepancy and femoral neck-shaft angle (NSA) significantly improved in both groups postoperatively (P＜0.05). However, the ESIN cohorthad greater NSA than the LIN cohort (P＜0.05). [Conclusion] ESIN used for relatively stable femoral fractures is simple, safe and has goodfunctional recovery. However, for relatively unstable fractures, LIN fixation may be considered.