不同髓内针直径与髓腔峡部直径之比的弹性髓内针治疗儿童股骨干骨折的比较  

Efficacy comparisons of flexible intramedullary nailing with different ND/MCD ratios for pediatric femoral shaft fractures

作　　者：王勇[1] 刘万林[1] 白锐[1] 赵振群[1] 吉利[1] 李云隆 孙亮[1] Wang Yong;Liu Wanlin;Bai Rui;Zhao Zhenqun;Ji Li;Li Yunlong;Sun Liang(Second Affiliated Hospital,Inner Mongolia Medical University,Hohhot 010030,China)

机构地区：[1]内蒙古医科大学第二附属医院,呼和浩特010030

出　　处：《中华小儿外科杂志》2020年第4期346-350,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的 比较不同髓内针直径与髓腔峡部直径之比(nail diameter/medullary canal diameter ratio,ND/MCD)的弹性髓内针治疗儿童股骨干骨折的临床疗效。方法 将2015年7月至2018年6月内蒙古医科大学第二附属医院收治的308例股骨干骨折儿童纳入前瞻性研究对象。年龄5.2~11.7岁,平均8.6岁;平均体质量指数(BMI)19.7 kg/m2;其中男187例,女121例;左侧163例,右侧145例;不稳定骨折130例,占42.2%(130/308)。所有患儿均采取逆行弹性髓内针内外侧穿针技术治疗,手术操作由同一位资深高级职称医生主刀或指导完成。术前应用随机数字表法将患儿分为A、B两组,A、B两组分别为154例。A组选择弹性髓内针时要求其直径满足ND/MCD>60%而<80%;B组直径要求满足ND/MCD≥80%。两组患儿在术前一般资料及影像学表现上的差异无统计学意义(P>0.05)。两组的术前准备、手术步骤、术后治疗及康复训练相同。记录并比较两组畸形愈合、骨折不愈合率,以及手术时间、内固定物取出时间、感染、针尾激惹发生比例。组间比较采用独立样本t检验,计数资料比较采用χ2检验,等级资料采用秩和检验。结果 所有患儿均获得随访,平均随访时间为A组8.7个月,B组8.9个月。两组患儿在畸形愈合率、骨折不愈合率、感染率、针尾激惹发生比例上的差异无统计学意义。平均手术时间、内固定物取出所需时间A组明显较B组短,差异具有统计学意义。所有患儿内固定物取出前患肢功能及步态均恢复正常。结论 弹性髓内针治疗儿童股骨干骨折,ND/MCD>60%可获得满意的临床疗效,且与≥80%时相比,ND/MCD在60%~80%时手术操作更容易。Objective To assess the clinical efficacy of flexible intramedullary nailing(FIMN)with different ratios of summed nail to intramedullary canal diameter(ND/MCD)for pediatric femoral shaft fractures.Methods A prospective study was performed for a consecutive series of 308 patients with femoral shaft fracture from July 2015 to June 2018.They were randomly divided by a random number table method into two groups of A and B.There were medial and lateral,retrograde FIMN.Nail diameters fulfilled ND/MCD between 60%and 80%in group A and ND/MCD≥80%in group B.Preoperative radiographs were analyzed to determine fracture pattern,location and isthmic canal diameter.Preoperative radiographs for removing implants were acquired for measuring the parameters of shortening,coronal angulation,and sagittal angulation.The rate of malunion,fracture nonunion,infection,tail stimulation,operative duration and removal of implants were compared between two groups.Results All children were followed up.The average follow-up period was 8.7 months for group A and 8.9 months for group B.When groups A and B were compared,no significant inter-group differences existed in age(8.8 vs.8.4y),gender(60.4%vs.61.0%males),body mass index(19.5 vs.19.9 kg/m2)or unstable fractures(43.5%vs.40.9%).Group A showed no higher rate of malunion(4.5%vs.3.2%,P>0.05),fracture nonunion,infection(0.6%vs.1.9%,P>0.05)or tail stimulation.However,there were significantly longer operative duration(47.2 vs.61.7 min,P<0.05)and removal time of implants.Prior to removing implants,extremity function and gait of all children normalized.Conclusions Satisfactory clinical efficacies may be obtained by using FIMN with>60%ND/MCD ratio for pediatric femur fractures.As compared with≥80%ND/MCD ratio,surgery and removal of implants are easier between 60%and 80%.

关 键 词：儿童 弹性髓内针 股骨干骨折 前瞻性研究 

分 类 号：R726.8[医药卫生—儿科]