经皮撬拔复位钛弹性髓内钉治疗儿童不稳定型股骨转子下骨折  

Clinical efficacy of percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation in treatment of unstable femoral subtrochanteric fracture in children

作　　者：陈笑天[1] 吴敏[1] 官建中[1] 王照东[1] 肖玉周[1] 伍开翠[1] CHEN Xiao-tian;WU Min;GUAN Jian-zhong(Department of Orthopedics, The First Affiliated Hospital of Bengbu Medical College, Anhui, 233004, China)

机构地区：[1]蚌埠医学院第一附属医院骨科

出　　处：《淮海医药》2019年第4期349-352,355,共5页Journal of Huaihai Medicine

基　　金：安徽省2016年科技计划项目(1604a0802090);安徽省卫生计生适宜技术推广项目(2016-TG07)

摘　　要：目的:探讨经皮克氏针撬拔复位钛弹性髓内钉内固定治疗儿童不稳定型股骨转子下骨折的临床疗效。方法:选择2014年1月—2016年12月某院收治的16例不稳定型股骨转子下骨折患儿,其中男10例,女6例,年龄4~11(5.4±1.8)岁。患者入院后即予以患肢皮牵引制动。受伤至手术时间为1~6(3.5±1.9)天。所有患儿的手术方案均为经皮克氏针撬拔复位钛弹性髓内钉内固定。结果:术后所有患儿切口均一期愈合,无脂肪液化、切口皮缘坏死、感染及血管神经损伤等并发症发生。16例患儿获得18~30(23.4±2.9)个月随访。患儿均获得骨性愈合,愈合时间12~20(14.8±2.2)周,随访期间无钉尾皮肤激惹、股骨头坏死、骨骺早闭、髓内钉变形折断、肢体短缩或过度生长、再骨折等并发症发生。患儿均有不同程度的向前成角,3~8°(5.3±1.7)°,所有患儿均无内外翻成角。末次随访时Harris髋关节功能评分为86~97(92.6±3.0)分,优良率100%。结论:采用经皮克氏针撬拔复位钛弹性髓内钉内固定治疗儿童不稳定型股骨转子下骨折是一种安全有效的手术方法,其并发症少,风险小,临床疗效满意。Objective: To discuss the clinical efficacy of percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation in treatment of unstable femoral subtrochanteric fractures in children. Methods: 16 cases of unstable femoral subtrochanteric fractures treated in a hospital from January 2014 to December 2016 were selected, including 10 males, 6 females, aged 4 to 11 years, with an average age of (5.4±1.8) years. All the cases were given skin and limb traction braking. The time from injury to surgery was 1 to 6 days, with an average of (3.5±1.9) days. The surgical method used was percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation. Results: All incisions after the operation were primary healing, with no complications occurring such as fat liquefaction, incision skin edge necrosis, infection or injury of blood vessel. The 16 patients were followed up for 18 to 30 months, with an average of (23.4±2.9) months. All of them acquired bone union, the union time being 12 to 20 weeks, with an average of (14.8±2.2) weeks. During the follow-up, no complications such as skin irritation of nail end, femoral head necrosis, early closure of epiphyseal, deformation or fracture of intramedullary nail, limb shortening or overgrowth, and re-fracture occurred. All the patients had different degrees of anterior angulation, ranging from 3 to 8°, with an average of (5.3±1.7)°. All the patients had no varus and valgus angulation. At the last follow-up, the Harris hip joint function score was 86~97 points, with an average of (92.6±3.0) points and good rate of 100%. Conclusion: Percutaneous Kirschner wire poking reduction with titanium elastic intramedullary nail internal fixation is a safe and effective surgical method with fewer complications, less risk and more satisfactory clinical efficacy.

关 键 词：股骨转子下骨折 弹性髓内钉 骨折固定术 内 儿童 

分 类 号：R726.8[医药卫生—儿科]