儿童股骨颈骨折闭合复位内固定的疗效观察  

Analysis of Therapeutic Efficacy of Closed Reduction and Internal Fixation for Delbet Type Ⅱ,Ⅲ Femoral Neck Fractures in Children

作　　者：宫伟 李炳钻 王建嗣 叶萍萍 揭强 练志平 GONG Wei;LI Bingzuan;WANG Jiansi;YE Pingping;JIE Qiang;LIAN Zhiping(Department of Pediatric Orthopaedics,Quanzhou Orthopaedic-Traumatological Hospital,Quanzhou 362000,Fujian China)

机构地区：[1]福建泉州市正骨医院小儿骨科,福建泉州362000

出　　处：《中国中医骨伤科杂志》2022年第4期30-33,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨DelbetⅡ、Ⅲ型儿童股骨颈骨折行闭合复位空心螺钉内固定治疗的临床疗效。方法:回顾性分析本院2009年1月至2019年8月期间手术治疗的DelbetⅡ、Ⅲ型儿童股骨颈骨折48例(48髋),均借助骨科牵引床,施以轻柔的手法进行闭合复位和空心螺钉内固定。根据手术时机的不同分为两组:早期复位组为伤后24 h以内手术,有20髋;延迟复位组为伤后超过24 h手术,有28髋。术后复查时根据Song提出的标准评估骨折复位质量,根据Ratliff标准评定临床疗效,并记录患者发生的并发症。结果:48例患者均获得随访,时间12~42个月(20.80±6.43)。所有骨折均获得愈合,愈合时间8~14周(9.80±1.41)。髋人字石膏或支具制动时间6~10周(7.80±1.08)。完全负重时间3~6个月(4.80±0.87)。术后共发现有7例股骨头缺血性坏死,发生率为14.6%(7/48)。其中早期复位组3例(15.0%,3/20),延迟复位组4例(14.3%,4/28)。术后12个月时根据Ratliff标准评定临床疗效:总体优良率为83.3%,早期复位组优良率为85.0%(17/20),延迟复位组优良率为82.1%(23/28)。结论:DelbetⅡ、Ⅲ型儿童股骨颈骨折采用闭合复位空心螺钉内固定,可取得满意的临床疗效,且早期闭合复位和延迟闭合复位的疗效没有明显差别。Objective:To investigate the clinical efficacy of closed reduction and cannulated screw fixation for Delbet type Ⅱ,Ⅲ femoral neck fractures in children.Methods:48 cases(48 hips) of Delbet type Ⅱ,Ⅲ femoral neck fractures in children treated by operation from January 2009 to August 2019 were retrospectively analyzed.With the help of orthopedic traction bed,all patients were treated with gentle closed reduction and cannulated screw fixation.According to the timing of operation,they were divided into two groups:the early reduction group(20 hips) was operated within 24 h after injury;delayed reduction group(28 hips) was performed more than 24 h after injury.The quality of fracture reduction was evaluated according to Song’s criteria.The curative efficacy was evaluated according to the Ratliff’s criteria,and the complications were recorded.Results:All the 48 patients were followed up from 12 to 42 months(average(20.80±6.43) months).The fracture union time ranged from 8 to 14 weeks(average(9.80±1.41) weeks).The immobilization time of hip plaster or brace was from 6 to 10 weeks(average(7.80±1.08) weeks).The time of complete weight-bearing was from 3 to 6 months(average(4.80±0.87) months).There were 7 cases of femoral head necrosis for all the 48 patients,and the incidence rate was 14.6%(7/48).There were 3 cases of femoral head necrosis(15.0%,3/20) in early reduction group and 4 cases of femoral head necrosis(14.3%,4/28) in delayed reduction group.By the Ratliff’s criteria at 12 months after operation,the excellent and good rate was 85.0%(17/20) in the early reduction group and 82.1%(23/28) in the delayed reduction group.Conclusion:Delbet type Ⅱ,Ⅲ femoral neck fractures in children are treated with closed reduction and cannulated screw fixation,and the clinical efficacy is satisfactory.There is no significant difference in the efficacy between early reduction and delayed reduction.

关 键 词：股骨颈骨折 延迟治疗 闭合复位 空心螺钉内固定 儿童 

分 类 号：R683.42[医药卫生—骨科学]