延迟复位的儿童移位型股骨颈骨折的治疗  

Delayed treatment of 51 pediatric displaced femoral neck fractures

作　　者：郑朋飞[1] 鞠黎[1] 陈杰[1] 唐凯[1] 楼跃[1] 

机构地区：[1]南京医科大学附属南京儿童医院骨科,南京医科大学数字医学研究所,210008

出　　处：《中华创伤骨科杂志》2016年第5期375-380,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较闭合复位与切开复位治疗超过24h复位的儿童股骨颈骨折的临床疗效。方法回顾性分析2005年5月至2012年5月期间收治的51例超过24h复位的儿童股骨颈骨折患者资料，男37例，女14例；年龄为1．7—15．5岁，平均9．1岁。骨折根据Delbet分型：Ⅱ型27例，Ⅲ型18例，Ⅳ型6例。根据最终复位方式不同分为2组：闭合复位组（18例）和切开复位组（33例）。记录患者有无并发症发生，根据Ratliff标准评定疗效，比较两组患者的治疗结果。结果51例患者术后获平均36．7个月（17—61个月）随访。闭合复位组和切开复位组分别有6例（33．3％）、29例（87．9％）患者骨折获得解剖复位。除闭合复位组1例患者发生骨不连外，其余患者骨折均获愈合，愈合时间平均为10．9周（9～13周）。闭合复位组患者股骨头缺血性坏死的发生率（27．8％，5／18）显著高于切开复位组患者（15．2％，5／33），末次随访时根据Ratliff标准评定疗效：闭合复位组患者优良率（66．7％，12／18）显著低于切开复位组患者（84．8％，28／33），以上项目两组间比较差异均有统计学意义（P〈0．05）。闭合复位组3例患者发生髋内翻畸形，切开复位组无一例患者发生髋内翻畸形。结论对于超过24h接受复位的儿童移位型股骨颈骨折，切开复位较闭合复位内固定效果更佳，原因可能与切开复位的骨折复位质量更好有关。Objective To compare open versus closed reduction in treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours. Methods We retro- spectively reviewed 51 children who had been treated at our department for femoral neck fracture between May 2005 and May 2012 after their reduction had been delayed for more than 24 hours. They were 37 boys and 14 girls, 1.7 to 15.5 years of age （average, 9. 1 years）. According to Delbet＇s classification, 27 cases belonged to type Ⅱ, 18 to type Ⅲ, and 6 to type Ⅳ. Of them, 18 underwent closed reduction and 33 open reduction. Their complications were recorded in detail. Their therapeutic results were evaluated according to Ratliff＇ s criteria and compared between the 2 methods of reduction. Results The 51 children were followed up for an average of 36. 7 months （range, from 17 to 61 months）. Anatomic reduction was achieved in 6 cases in the closed reduction group （33.3%） and 29 cases in the open reduction group （87.9%）, respectively. All fractures healed after an average of 10.9 weeks （range, from 9 to 13 weeks）, with one exception of nonunion in the closed reduction group. The incidence of femoral head necrosis in the closed reduction group （27.8%, 5/18） was significantly higher than that in the open reduction group （15.2%, 5/33） （P 〈 0. 05） . According to the Ratliff＇ s evaluation at the final follow-ups, the good to excellent rate in the closed reduction group（66.7%, 12/18） was significantly lower than that in the open reduction group （84. 8%, 28/33） （P 〈 0. 05） . Coxa vara occurred in 3 children in the closed reduction group but in none in the open reduction group. Conclusion Open reduction with internal fixation may lead to better outcomes than closed reduction in the treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours, probably because open reduction can result in better reduction quality.

关 键 词：股骨颈骨折 骨折固定术 内 儿童 

分 类 号：R726.8[医药卫生—儿科]