钢板与髓内钉辅助儿童股骨延长的效果比较  

The comparison between plate and nail-assisted lengthening of the femurs in children

作　　者：杨征[1] 王玉琨[1] 周达飞[1] 姜宇[1] 徐雷[1] 张宇辰[1] 段芳芳 Yang Zheng;Wang Yukun;Zhou Dafei;Jiang Yu;Xu Lei;Zhang Yuchen;Duan Fangfang(Department of Pediatric Orthopedics,BeijingJishuitan Hospital,Beijing 100035,China;Clinical Epidemiology Research Center,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院小儿骨科,100035 [2]北京积水潭医院临床流行病学研究室,100035

出　　处：《中华骨科杂志》2021年第12期770-779,共10页Chinese Journal of Orthopaedics

摘　　要：目的针对儿童股骨大段延长病例,比较髓内钉辅助延长技术和钢板辅助延长技术在治疗成本和治疗效果上的差异;在钢板辅助技术中对是否拆架同期立即钢板固定进行对比研究,以分析该技术合理的技术路线。方法自2014年1月7日至2018年9月10日共规划完成辅助延长手术21例,男12例,女9例;手术年龄(12.43±3.12)岁(范围6~18岁)。行髓内钉辅助延长手术者10例,钢板辅助延长者11例。钢板组中,拆架同期固定5例,非同期固定6例。在髓内钉组和钢板组间,以及钢板组内同期和非同期两亚组,比较系列手术总时长、总出血量、延长段愈合速度、并发症、术后功能等指标。采用SPSS 22.0软件进行统计分析,提出合理的治疗策略。结果髓内钉组延长长度为7.10(6.63,7.70)cm,钢板组为6.00(5.00,8.00)cm;髓内钉组总手术时间为300(240,330)min,钢板组为260(230,465)min;髓内钉组愈合速度为1.12(0.78,1.72)月/cm,钢板组1.00(0.75,1.71)月/cm;髓内钉组并发症3例,钢板组3例;髓内钉组膝关节活动度为125.00°(117.50°,150.00°),钢板组100.00°(90.00°,150.00°)。各指标组间差异均无统计学意义(P均>0.05)。钢板组中,拆架同期与非同期固定,在延长长度、愈合速度、手术次数、总出血量,术后功能上组间差异无统计学意义(P均>0.05)。结论髓内钉和钢板辅助技术在治疗成本和治疗效果上接近,术者可根据患者生长潜力和自己的习惯术式进行选择;钢板辅助技术中是否拆架同期钢板固定,在当前样本量下无明显差异。Objective In this study,lengthening over nail(LON)and plating after lengthening(PAL)were compared by the process of treatment and therapeutic effect in the children's femoral lengthening cases,to guide treatment choices;and in the PAL group there was another comparison between different timeline of plate fixation after lengthening to formulate reasonable technical route.Methods Since January 7,2014 to September 10,2018,a total of 21 cases of LON and PAL surgery had been carried out,including 12 males and 9 females.The average age at their operation was 12.43±3.12 years.There were 10 patients in the LON group and 11 patients in the PAL group,in the PAL group 5 cases was synchronous fixation,which means removal of the external fixator and plate fixation would be performed in the same surgery,6 cases was asynchronous fixation,which means plate fixation would be performed at least 2 weeks later after the removal offixator to reduce the risk of infection.The recorded data includesgender,date of birth,reason of discrepancy and treatment history,age at surgery,lengthening distance,the length of duration with frame,healing time,total duration time and total blood loss of seriesoperations,ROM of the knee joint,complications,etc.Statistical analysis was made by SPSS 22.0 software,and then reasonable treatment strategies were proposed.Results In the LON group,the medianlengthening distance was 7.10(6.63,7.70)cm,the median total duration time was 300(240,330)min,the medianspeed of healing was 1.12(0.78,1.72)month/cm,complications were found in 3 cases,the median ROM of knee joint was 125.00°(117.50°,150.00°);in the PAL group,the data respectively were 6.00(5.00,8.00)cm,260(230,465)min,1.00(0.75,1.71)month/cm,3 cases,100.00°(90.00°,150.00°),the difference between them was not statistically significant(all P>0.05).2.In the PAL group,the difference of number of surgeries,total duration time,total blood loss,complication rate,healing speed and postoperative function between synchronous and asynchronous fixation was not st

关 键 词：骨延长术 内固定器 外固定器 儿童 对比研究 

分 类 号：R726.8[医药卫生—儿科]