小切口复位与闭合复位弹性钉治疗儿童股骨干骨折的比较研究  

Mini-open versos closed reduction using titanium elastic nailing for paediatric femoral shaft fractures

作　　者：孙辽军[1] 杨杰[1] 余贤斌[1] 陈华[1] 郭晓山[1] 

机构地区：[1]温州医学院附属第二医院骨科,325027

出　　处：《中华小儿外科杂志》2013年第9期673-677,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的比较小切口复位与闭合复位弹性钉固定儿童股骨干骨折的影像学结果及临床疗效。方法2008年2月至2009年12月，收治68例年龄4～15岁的股骨骨折患儿，其中34例采用小切口复位弹性钉固定，男22例，女12例；年龄（8．2±2．5）岁；左侧10例，右侧24例；横形骨折18例，斜形12例，螺旋形4例。34例采用闭合复位弹性钉固定，男18例，女16例；年龄（8．6±2．6）岁；左侧14例，右侧20例；横形骨折15例，斜形14例，螺旋形5例。术前两组患儿一般资料具有可比性。分别对两组患儿手术时间、术中射线暴露时间及术后的影像学结果、临床疗效及并发症进行对比分析。结果与闭合复位弹性钉固定组相比，小切口复位组手术时间[（30．5±8．5）min vs．（53．0±15．0）min，P〈0．001]及术中放射线暴露时间[（28．4±18．5）SVS．（65．0±28．5）S，P〈0．001]明显缩短，两组差异有统计学意义。两组骨折愈合时间[（5．8±1．3）周 vs．（5．7±1．4）周，P〉0．051、完全负重时间[（10．5±2．5）周VS．（9．8±2．4）周，P〉0．05]及并发症发生率差异无统计学意义。根据弹性钉评分系统，小切口组优31例，良3例；闭合复位组优29例，良5例，两组影像学结果及临床疗效差异无统计学意义。结论小切口复位治疗儿童股骨骨折与闭合复位治疗的总体疗效相当，但小切口复位可以明显缩短手术时间及减少放射线暴露，可以作为闭合复位困难时的优先选择。Objective To compare the radiological and clinical results in pediatric femoral shaft fractures treated with either mini-open reduction or closed reduction and titanium elastic nailing. Methods From February 2008 to December 2009, 68 children with femoral shaft fractures were treated with a mini-open reduction and nail fixation （34 patients, 22 males and 12 females, mean age of 8. 2 ± 2. 5 years） and closed reduction and nail fixation （34 patients, 18 males and 16 females, mean age of 8. 6 ± 2. 6 years） respectively. Duration of operation and intraoperative fluoroscopy time were recorded in both groups. Clinical and radiological outcomes were assessed using the TEN scoring system. Resuits Both surgical and fluoroscopy time were significantly longer in closed reduction group. There were no significant differences between fracture healing time, full weight bearing time and complications. According to TEN Scoring System, mini-open reduction group was excellent in 31 cases, good in 3 cases. In closed reduction group, excellent was seen in 29 cases, good in 5 cases. There was no significant difference between the two groups in terms of clinical and radiological results. Conclusions Mini-open reduction provides the same satisfactory clinical results as closed reduction. It is an alternative method of closed reduction to prevent extensive intraoperative radiation exposure and to decrease the length of the surgical procedure.

关 键 词：钛弹性钉 X线透视检查 股骨骨折 

分 类 号：R726.8[医药卫生—儿科]