髓内钉固定治疗青少年股骨干骨折的疗效分析  

Clinical outcomes of intramedullary nailing for femoral shaft fracture in adolescents

作　　者：马洪[1] 沈钊雄[1] 郭跃明[1] Ma Hong;Shen Zhaoxiong;Guo Yueming(Department of Pediatric Orthopaedics,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]佛山市中医院小儿骨科,528000

出　　处：《中华创伤骨科杂志》2021年第3期262-266,共5页Chinese Journal of Orthopaedic Trauma

基　　金：广东省医学科学技术研究项目(20161181228306)。

摘　　要：目的探讨髓内钉固定治疗青少年股骨干骨折的临床疗效。方法回顾性分析2017年5月至2019年10月期间佛山市中医院小儿骨科收治的30例青少年股骨干骨折患者资料。男20例,女10例;年龄为12~17岁,平均14岁;左侧13例,右侧17例。手术均采用髓内钉固定:12例患者行切开复位固定,18例患者行闭合复位内固定。记录患者的手术时间、术中出血量、抗生素使用时间,比较患者末次随访时健侧与患侧的下肢长度、颈干角、股骨颈最宽径、关节面转子间距离及髋关节Harris评分等。结果18例闭合复位和12例切开复位患者的术中出血量平均分别为153.2、238.0 mL,手术时间平均分别为70.5、91.5 min,抗生素使用时间平均分别为1.5、3.0 d。30例患者术后获12~41个月(平均20.3个月)随访。随访期间无一例患者发生感染、骨折不愈合、延迟愈合及畸形愈合等并发症。末次随访时1例患者双下肢长度不等长,但差值<1 cm。末次随访时30例患者患侧颈干角、股骨颈最宽径、关节面转子间距离、髋关节Harris评分分别为[133.4°±2.3°、(29.3±4.2)mm、(27.1±6.3)mm、(96.4±3.6)分],与健侧[132.4°±3.5°、(30.2±3.6)mm、(26.4±6.8)mm、(95.6±4.7)分]比较差异均无统计学意义(P>0.05)。结论髓内钉固定治疗青少年股骨干骨折的疗效确切,并发症少,对股骨近端发育影响小。Objective To evaluate the clinical efficacy of intramedullary nailing for femoral shaft fracture in adolescents.Methods From May 2017 to October 2019,30 adolescent patients with femoral shaft fracture were treated at Department of Pediatric Orthopaedics,Foshan Hospital of Traditional Chinese Medicine.They were 20 males and 10 females,aged from 12 to 17 years(average,14 years),with 13 left and 17 right sides affected.They were all fixated with intramedullary nailing;open reduction and internal fixation was performed in 12 cases and closed reduction and internal fixation in 18 cases.Recorded were operation time,intraoperative blood loss,and time for postoperative antibiotic use;compared were lower limb length,neck-shaft angle,femoral neck diameter(FND),articular trochanteric distance(ATD)and Harris scores between the healthy and affected sides at the final follow-up.Results For the 18 patients undergoing closed reduction and 12 patients undergoing open reduction,respectively,the intraoperative blood loss averaged 153.2 mL and 238.0 mL,the operation time 70.5 min and 91.5 min,and the time for antibiotic use 1.5 d and 3.0 d.The 30 patients were followed up for 12 to 41 months(average,20.3 months).Follow-up revealed no such complications as fracture nonunion,delayed union,malunion,heterotopic ossification of the hip,refracture of the femoral shaft,or developmental deformity of the proximal femur.The lower limb length,neck-shaft angle,FND,ATD and Harris scores at the final follow-up were,respectively,133.4°±2.3°,(29.3±4.2)mm,(27.1±6.3)mm and 96.4±3.6 for the affected side,insignificantly different from those for the healthy side[132.4°±3.5°,(30.2±3.6)mm,(26.4±6.8)mm and 95.6±4.7](P>0.05).Conclusion Intramedullary nailing is effective for femoral shaft fracture in adolescents,leading to positive efficacy and limited complications and impact on the development of proximal femur.

关 键 词：股骨骨折 骨折固定术 髓内 骨钉 青少年 

分 类 号：R726.8[医药卫生—儿科]