弹性钉加尾帽治疗儿童长度不稳定型股骨干骨折  

Titanium elatic intramedullary nail and end caps to treat length-unstable femoral shaft fracture of children

作　　者：王侃[1] 杨建平[1] 张中礼[1] 解礼伟[1] 付喆[1] 邓书贞[1] 陈兆强[1] 

机构地区：[1]天津市天津医院小儿骨科,300211

出　　处：《中华骨科杂志》2016年第24期1606-1612,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨弹性钉加尾帽治疗儿童长度不稳定型股骨干骨折的临床疗效。方法回顾性分析2011年12月至2014年6月采用弹性钉加尾帽治疗21例儿童长度不稳定型股骨干骨折患儿资料，男15例，女6例；5岁6个月-10岁10个月，平均7岁5个月。患儿术前均经3~7d牵引，牵引重量为体重的1／4-1／6，经牵引后股骨干骨折短缩及成角畸形均较前明显减小。手术于全麻下行股骨干骨折闭合复位逆行弹性钉内固定，弹性钉呈结构对称的双“C”形弹性支撑。弹性钉钉尖外侧止于大转子骺板下，内侧止于股骨头骺板下，将钉尾剪短；尾帽套入钉尾并拧入钉尾远端骨皮质内，使钉尾与骨折端相对固定。术后采用石膏裤固定4周。以术后2年为观测终点，分析随访结果。结果21例患儿均获得随访，随访时间22~26个月，平均23．4个月。患儿在术后4周去除石膏裤行练习活动，并逐渐下地负重。所有骨折均愈合，愈合时间5-8周，平均6．2周。终末随访时患儿患肢力线好，无成角畸形，股骨过度生长4．2～21．1mm，平均6．1mm。在末次随访时，对患儿患侧肢体行Harris评分，优良率为100％；无一例发生弹性钉自股骨远端进钉点退出、髋关节活动受限、骨折不愈合、延迟愈合等并发症。1例患儿有轻度跛行，但所有患儿家长均对治疗效果表示满意。结论弹性钉加尾帽固定是治疗长度不稳定型儿童股骨干骨折的有效方法，可有效降低弹性钉自股骨远端进钉点退出的风险。Objective To evaluate the outcome of Titanium Elatic Intramedullary Nail （TEINs） for treatment of length- unstable femoral shaft fracture of children. Methods Retrospectively analyze the data of total of 21 children with length-unstable femoral shaft fractures, from December 2011 to June 2014, were treated with TEINs and end caps. This study involved 15 boys and 6 girls, with age ranged from 5 years and 6 months to 10 years and 10 months, whose average age was 7 years and 5 months. Firstly children were treated with traction for 3-7 days, with traction weight of 1/4 to 1/6 of the weight. After that, shortening and angular deformity were significantly corrected. Then surgeries of close reduction and internal fixation with TEINs were done in gen- eral anesthesia. TEINs were supported with double nail ＂C＂ shape. The lateral tip of TEIN located near the epiphyseal plate of greater trochanter, and the medial tip near the epiphyseal plate of femur head. Cut the tail of TEINs, set and screw the end caps in- to cortex, keeping the tail of TEINs and fracture fixed. Spica casting was used for 4 weeks after operation. The last follow-up time was 2 years, and the follow up results were analyzed. Results 21 children were followed up ranged from 22 to 26 months, with the mean follow up 23.4 months. Remove the spica casting and bear loading at 4 weeks after operation. All fractures healed, with healing time of 5 to 8 weeks （an average of 6.2 weeks）. At the last follow-up, the limb force line was good with no angular deformi- ty. Femur overgrew 4.2-21.1 mm, with an average of 6.1 mm. At the last fallow-up, the patients were evaluated with Harris score, and the excellent and good rate was 100%. No case of TEINs push-out, limited hip mobility, fracture nonunion, delayed healing or other complications was found. Only 1 case got a mild lameness. All parents were satisfied with their outcome. Conelution TEINs and end caps are effective methods for the length-unstable femoral shaft fracture in children. These results indic

关 键 词：儿童 股骨骨折 内固定器 骨折固定术 髓内 

分 类 号：R726.8[医药卫生—儿科]