带锁髓内钉和锁定钢板治疗青少年股骨干骨折的对比研究  

Comparison of interlocking intramedullary nail versus locking plate fixation in juvenile femoral shaft fractures

作　　者：黄立明[1] 汪文涛 潘源城[2] 黄殿华 卢育南 陈顺有[2] Huang Liming;Wang Wentao;Pan Yuancheng;Huang Dianhua;Lu Yunan;Chen Shunyou(Department of Orthopedic Surgery,Second Municipal Hospital,Sanming 366000,China;Department of Pediatric Orthopedic Surgery,Second Municipal Hospital,Xiamen University,Fuzhou 350007,China)

机构地区：[1]三明市第二医院骨科,福建省三明市366000 [2]福州市第二医院小儿骨科,福建省福州市350007

出　　处：《临床小儿外科杂志》2019年第2期124-129,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的目的比较经大转子外侧进带锁髓内钉和锁定钢板治疗青少年股骨干骨折的临床疗效。方法回顾性分析2014年5月至2016年5月由三明市第二医院和福州市第二医院收治的29例青少年股骨干骨折患儿的临床资料。根据治疗方法的不同分为带锁髓内钉组(n=16)和钢板组(n=13)。记录并比较两组患儿的切口长度、出血量、早期下地负重时间和临床愈合时间。末次随访时,测量并比较双侧的颈干角及冠状位股骨干轴线成角。采用NAHS评分法评估两组患儿患侧的髋关节功能。结果髓内钉组的切口长度为(5.27±0.39)cm,钢板组(7.66±0.41)cm,差异有统计学意义(t=2.287,P=0.011);髓内钉组出血量和早期下地负重时间分别为(131.88±6.43)mL和(52.81±3.37)d,钢板组分别为(145.25±7.79)mL和(64.35±3.42)d,差异均有统计学意义(P<0.05)。髓内钉组达到临床愈合的时间为(60.25±3.86)d,钢板组为(70.63±8.87)d,差异有统计学意义(t=2.594,P=0.028)。髓内钉组患侧颈干角、冠状位股骨干轴线成角分别为(150.11±1.62)°和(178.88±0.49)°,健侧分别为(150.20±1.01)°和(178.84±0.34)°,差异均无统计学意义(P >0.05)。钢板组患侧颈干角、冠状位股骨干轴线成角分别为(150.37±1.11)°和(178.88±1.09)°,健侧为(149.98±0.98)°和(179.12±0.42)°,差异均无统计学意义(P >0.05)。髓内钉组和钢板组髋关节的NAHS评分分别为(94.19±2.37)分和(94.46±2.22)分,差异无统计学意义(t=0.317,P=0.748)。末次随访时29例患儿均达到骨性愈合。钢板组有1例出现螺钉松动并延迟愈合,1例出现轻微股骨远端外翻畸形。结论相对于锁定钢板,带锁髓内钉治疗青少年股骨干骨折具有切口小,出血量少,愈合快,并发症少等优点。Objective To compare the clinical outcomes of interlocking intramedullary nail fixation using a lateral trochanteric entry point versus locking plate fixation in the treatment for juvenile femoral shaft fracture.Methods For this retrospective comparative study,a total of 29 inpatients of Sanming Second Municipal Hospital or Fuzhou Second Affiliated Hospital of Xiamen University undergoing interlocking intramedullary nail fixation using a lateral trochanteric entry point or locking plate fixation because of juvenile femoral shaft fracture were recruited between May 2014 and May 2016.And the interventions included intramedullary nail group(n=16)and plate group(n=13)according to treatment methods.Length of incision,volume of blood loss,time of weight-bearing and time of fracture healing were compared between two groups.At the final visit,neck-shaft angle and femoral shaft axis angulation in frontal plane were measured radiologically and compared to uninjured side.Also non-arthritic hip score(NAHS)was utilized for evaluating the hip joint function of injured side.The differences were compared between two groups.Results The lengths of incision of both groups were(5.27±0.39)and(7.66±0.41)cm respectively and the differences were not statistically significant(t=0.972,P=0.011);volume of blood loss and time of weight-bearing were(131.88±6.43)mL and(52.81±3.37)days in intramedullary nail group versus(145.25±7.79)mL and(64.35±3.42)days in another group respectively.Statistically significant differences existed between two groups(P<0.05).Time of fracture healing of both groups were(60.25±3.86)and(70.63±8.87)days respectively.And the differences were not statistically significant(t=0.886,P=0.028).In intramedullary nail group,neck-shaft angle and femoral shaft axis angulation in frontal plane of injured side were(150.11±1.62)°and(178.88±0.49)°while uninjured side(150.20±1.01)°and(178.84±0.34)°respectively.And the differences between two sides were not statistically significant(P >0.05).In plate group,neck-shaft

关 键 词：带锁髓内钉 锁定钢板 青少年 股骨干骨折 

分 类 号：R726.8[医药卫生—儿科] R683.42[医药卫生—临床医学]