弹性髓内钉在儿童长度不稳定型股骨骨折中的应用  

Elastic intramedullary nailing of length-unstable pediatric femoral shaft fractures

作　　者：罗义[1] 王林[1] 陈梦婕[1] 马琪超 王隼[1] 应灝 焦勤[1] LUO Yi;WANG Lin;CHEN Mengjie;MA Qichao;WANG Sun;YING Hao;JIAO Qin(Department of Orthopedics,Shanghai Children’s Hospital,Shanghai Jiaotong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院骨科上海交通大学附属儿童医院骨科

出　　处：《国际骨科学杂志》2019年第4期243-246,共4页International Journal of Orthopaedics

摘　　要：目的研究弹性髓内钉内固定治疗儿童长度不稳定型股骨骨折的疗效。方法回顾性分析2015年1月至2017年1月上海市儿童医院骨科收治的34例长度不稳定型股骨骨折(包括斜型或粉碎型儿童股骨骨折)患者的临床资料。依据不同的内固定方式将研究对象分为两组:髓内钉组(18例,接受弹性髓内钉治疗)、钢板组(16例,采取锁定加压钢板治疗)。记录手术时间、术中出血量、住院费用以及临床预后指标,包括骨折愈合时间、矢状位成角、冠状位成角、肢体不等长。结果研究对象中男21例,女13例;年龄(6.0±3.0)岁;粉碎型骨折22例,长斜型骨折12例。根据Winquist粉碎型分度,Ⅰ度12例,Ⅱ度6例,Ⅲ度和Ⅳ度各2例。对于儿童不稳定型股骨骨折,钢板组的手术时间以及术中出血量均明显高于髓内钉组(P均<0.05)。其他的临床指标两组之间无明显差异。髓内钉组住院费用为(2.27±0.32)万元,明显低于钢板组[(4.59±2.62)万元](P=0.001)。结论弹性髓内钉与锁定加压钢板治疗儿童不稳定型股骨骨折疗效相似,但手术时间更短、术中出血更少、费用更低。尽管两种置入物都可以用于儿童不稳定型股骨骨折,但本研究的结果更支持使用弹性髓内钉。Objective We aimed to evaluate the efficacy and cost-effectiveness of elastic intramedullary nailing(EIN)of length-unstable pediatric femoral shaft fractures.Methods Thirty-four patients with length-unstable femoral shaft fractures(including comminuted fractures and oblique fractures)treated in our hospital from January 2015 to January 2017 was included in this study.Cases were retrospectively reviewed regarding operation duration,intraoperative blood loss,medical costs,and treatment outcomes,including bone healing time,sagittal and coronal angulation and leg length discrepancy.EIN was applied in 18 cases,while the rest 16 cases were fixed with locking compression plates(LCP).Results There were 21 males and 13 females,aged(6.0±3.0)years,with 22 comminuted fractures and 12 long oblique fractures.According to the Winquist’s comminution classification,12 cases were gradeⅠ,6 cases gradeⅡ,and 2 cases gradeⅢand 2 gradeⅣrespectively.Patients fixed with LCP had significant longer operation duration and more blood loss than those fixed with EIN(P=0.016 and P=0.014,respectively).No significant difference was noted in terms of the treatment outcomes between the two groups.The medical costs in the EIN group were(22.7±3.2)thousand yuan,which was significantly lower than the LCP group[(45.9±26.2)thousand yuan](P=0.001).Conclusion EIN was superior to LCP fixation of pediatric femoral shaft fractures due to comparable treatment outcomes at the cost of shorter operation duration,less intraoperative blood loss and medical costs.Thus,EIN was favored in this study,though both types of fixation could be adopted.

关 键 词：股骨骨折 儿童 内固定 预后 

分 类 号：R68[医药卫生—骨科学]