可延长髓内钉治疗成骨不全症儿童股骨骨折或畸形的疗效分析  

The efficacy of telescopic intramedullary rod for treatment of femur fracture or deformity correction in children with osteogenesis imperfecta

作　　者：任秀智[1] 房凤岭 刘军龙[1] 窦从辉 周斌 石玉博 Ren Xiuzhi;Fang Fengling;Liu Junlong;Dou Conghui;Zhou Bin;Shi Yubo(Department of the Third Orthopaedics,Tianjin Wuqing District People's Hospital,Tianjin 301700,China)

机构地区：[1]天津市武清区人民医院骨三科,301700

出　　处：《中华骨科杂志》2019年第5期257-263,共7页Chinese Journal of Orthopaedics

基　　金：天津市武清区科技发展计划项目(WQKJ201527).

摘　　要：目的探讨可延长髓内钉治疗成骨不全症儿童股骨骨折或畸形的安全性和有效性,分析其预防股骨再骨折的作用及并发症。方法前瞻性分析2015年3月至2015年12月采用可延长髓内钉治疗65例(69侧)成骨不全症儿童股骨骨折或畸形资料,男39例,女26例;年龄3岁5个月至13岁4个月,平均9岁2个月。患儿术前股骨曾多次骨折并致骨干弯曲畸形,畸形成角度数30°~95°,平均58°。69侧股骨中,新发骨折21侧,股骨畸形48侧;单侧股骨61例,双侧股骨4例。依据扩展Sillence分型:Ⅰ型5例,Ⅲ型17例,Ⅳ型34例,Ⅴ型3例,Ⅵ型2例,XV型4例。结果 65例患儿均获得随访,随访时间15~43个月,平均32个月。股骨截骨愈合时间为7~12周,平均8周;待术后X线片示截骨愈合后患儿开始进行功能锻炼,至末次随访时52例患儿(80%,52/65)恢复站立和行走功能。患儿股骨骨折频率明显降低,由术前2~4次/年,平均(2.7±1.8)次/年,降至末次随访时0~1次/年,平均(0.5±0.2)次/年。65例患儿家长均对手术结果及畸形矫正效果表示满意。术后患儿生活自理能力明显改善。术后65例患儿的69侧股骨中,6侧再次发生不同程度骨折,其中1侧骨折需要再次手术更换髓内固定,4侧骨折无明显移位采用保守治疗后愈合,1侧骨折不愈合采用植骨及钢板加强固定后愈合。随访中3例(Ⅳ型1例,Ⅲ型2例)股骨的可延长钉远端内芯部分停止随骨骺生长而延长,但均未发生股骨骨折,故未进一步处理,继续观察;2例Ⅵ型患儿因近端外套钉尾移位而再次手术将钉尾重置于大转子内缘。2例股骨发生低毒感染,但骨折或截骨已经愈合,故手术取出髓内钉并采用抗生素治疗,感染痊愈;因未出现新发骨折或畸形而未再放置髓内钉,继续观察。结论可延长髓内钉可以矫正成骨不全患儿股骨畸形、增强肢体强度、有效预防成骨不全症儿童股骨再骨折。Objective To evaluate the safety and efficacy of telescopic intramedullary rod for treatment of femur fracture or deformity correction in children with osteogenesis imperfecta, and to analysis the result of prevention recurrent fracture as well as the complication.Methods Data of patients who were treated by telescopic intramedullary rod for recurrent femur fracture or curved femoral deformity from March 2015 to December 2015 were prospectively analyzed. There were 39 boys and 26 girls. The average age of the patients was 9 years 2 months, ranging from 3 years 5 months to 13 years 4 month. All the patients had suffered from recurrent femur fractures leading to femoral deformity. The mean angulation angle was 58°(range, 30°-95°). Among 69 sides, there were 21 sides of new fracture and 48 sides of deformity. Sixty-one patients were operated at one side and the other 4 patients were treated bilaterally. According to the modified Sillence classification system, there were 5 cases of type I , 17 type III, 34 type IV, 3 type V, 2 type VI and 4 type XV.Results All the 65 patients were followed up for a mean period of 32 months (range, 15-43). The average healing time of the osteotomy site or fracture site of the femur was 8 weeks (range, 7-12). The patient was encouraged to begin weight bearing and walking when the X-ray film showed healing of the osteotomy or fracture site. By the latest follow up, 80% of the patients could stand and walk independently. The incidence of femur fracture decreased significantly to the level of 0.5±0.2/year, compared to 2.7±1.8/year before operation. All the parents of the children were satisfied with the result of deformity correction. The children’s self care and motion ability improved obviously after operation. During follow up, 6 patients suffered from recurrent fracture of the femur by various degree, 1 of them was treated by open reduction and telescopic rodding surgery, while the other 5 patients were treated conservatively because the fracture displaced or angulated minimal

关 键 词：儿童 成骨不全 骨折 内固定器 骨折固定术 髓内 

分 类 号：R726.8[医药卫生—儿科]