改良Watson—Jones入路联合小儿髋部锁定加压接骨板治疗股骨颈骨折  

Modified Watson -Jones approach with locking compression paediatric hip plate for femoral neck fractures in children

作　　者：王波[1] 楼跃[1] 唐凯[1] 张志群[1] 林刚[1] 孙祥水[1] 刘飞[1] 倪磊[1] 鞠黎[1] 

机构地区：[1]南京医科大学附属南京儿童医院骨科,210008

出　　处：《中华实用儿科临床杂志》2016年第11期829-832,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨改良Watson—Jones入路联合小儿髋部锁定加压接骨板（LCP-PHP）治疗股骨颈骨折的方法及疗效。方法2012年1月至2014年8月南京医科大学附属南京儿童医院采用改良Watson-Jones入路联合LCP—PHP治疗11例闭合复位失败的股骨颈骨折患儿，其中男6例，女5例，平均年龄7．8岁；左侧5例，右侧6例。术前拍摄骨盆X线片，测量术前健侧股骨颈干角（颈干角）；术后定期复查X线片，测量术后3d和末次随访患侧颈干角，评估颈干角丢失情况及骨折愈合、骨骺早闭和股骨头坏死发生等情况，同时按Harris评分评估随访终末髋关节功能情况。结果全部病例获得随访，随访时间13～44个月，平均26个月，术前健侧颈干角为134．70°±3．58°，术后3d患侧颈干角为134．60°±3．46°，末次随访患侧颈干角为133．50°±3．25°，三者比较差异无统计学意义（F=3．63，P〉0．05），全部获得骨性愈合，无骨骺早闭，股骨头坏死1例（RafliffI型），Harris评分优9例（82．0％），良2例（18．0％）。结论对于闭合复位失败的儿童股骨颈骨折采用改良Watson—Jones入路联合LCP—PHP治疗，术野可以清晰显露骨折断端，直视下骨折复位，内固定坚强，并发症少。Objective To evaluate the methods and curative effect of modified Watson -Jones approach with locking compression paediatric hip plate （ LCP - PHP） for femoral neck fractures in children. Methods From January 2012 to August 2014,11 children including 6 male and 5 female with femoral neck fractures （5 lefts, 6 rights ） underwent operation of modified Watson - Jones approach with LCP - PHP in Nanjing Children＇s Hospital Affiliated to Nanjing Medical University. The average age at injury was 7.8 years old. All the children received preoperative X - ray and postoperative X - ray regularly. Neck stem angles of preoperative health side, neck stem angles of the sick side 3 days after surgery and the last fallow - up were measured, and the loss of neck stem angles, delayed union, nonunion, osteone- crosis, premature physeal closure were evaluated by using X - ray. Meanwhile, hip function of the last follow - up was evaluated by Harris score. Results All the patients were postoperatively followed up for 13 - 44 months with an average of 26 months. The neck stem angles of preoperative health side 134.70° ± 3.58°, postoperative sick side in 3 days 134. 60° ± 3.46° and the last follow - up 133.50° ± 3.25°, and there was no statistical difference （ F = 3.63, P 〉 0. 05 ）. The loss of neck stem angles, delayed union, nonunion, and premature physeal closure did not occur. Osteonecrosis（ Ratliff type Ⅰ ） occurred in 1 child. Harris score was very good in 9 cases （ 82.0% ） and good in 2 cases （ 18. 0% ）. Conclusions The modified Watson - Jones approach with LCP - PHP for unsuccessful closed reduction femur neck fractures in children can clearly show the fracture,with internal fixation stability and less complications.

关 键 词：改良Watson—Jones入路 小儿髋部锁定加压接骨板 股骨颈骨折 

分 类 号：R726.8[医药卫生—儿科]