弹性髓内钉治疗学龄前儿童股骨干骨折的疗效及预后分析  

Elastic intramedullary nail for preschool children femur fractures:a retrospective study of early results with analysis of efficacy and complications

作　　者：文玉伟 朱丹江[1] 王强[1] 宋宝健[1] 冯伟[1] WEN Yu-wei;ZHU Dan-jiang;WANG Qiang;SONG Bao-jian;FENG Wei(Department of Orthopaedics,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing,100045,China)

机构地区：[1]首都医科大学附属北京儿童医院骨科,国家儿童医学中心,北京100045

出　　处：《中国骨与关节杂志》2023年第11期806-811,共6页Chinese Journal of Bone and Joint

基　　金：十三五国家重点研发计划基金(2020YFC1107604)。

摘　　要：目的探讨应用弹性髓内钉治疗学龄前儿童股骨干骨折的疗效,分析影响预后的相关因素。方法回顾分析2016年1月至2022年1月,北京儿童医院应用弹性髓内钉治疗的3~6岁股骨干骨折患儿,共计32例,其中男22例,女10例;年龄3.1~5.9岁,平均(4.5±1.1)岁。收集基本信息和影像学资料,记录最终随访时冠状面、矢状面成角和相关并发症情况,分析影响预后的相关因素。结果本组随访时间12~36个月,平均24个月,所有患儿均实现闭合复位,按照Flynn标准优24例,满意8例,差0例。最终随访时所有患儿均获得骨折愈合,愈合时间(5.6±1.7)周,无术后再移位、骨折不愈合发生,术后针道激惹反应2例,无深部感染发生,残留矢状面成角7例,平均5.9°(5°~8°),残留冠状面成角7例,平均4.3°(3°~6°),双下肢不等长2例(差异分别为0.7 cm、1.0 cm),按照Flynn标准无不可接受的畸形发生。单因素分析受伤机制(χ2=4.885,P=0.053)、骨折位置(χ2=6.788,P=0.023)和术后即刻存在成角(χ2=5.788,P=0.035)是影响患儿最终残留成角的因素,多因素分析显示骨折位置(P=0.030,OR=9.991)是影响最终残留成角的独立危险因素。结论应用弹性髓内钉治疗学龄前儿童股骨干骨折疗效满意,术后并发症少,是该年龄段患儿的有效治疗方式,骨折位于远近端1/3时会增加成角畸形的风险。Objective To analyze the effect of elastic intramedullary nail for femoral shaft fractures in preschool children,and to explore the related factors affecting the prognosis.Methods We retrospectively analyzed the data of preschool children with femoral shaft fractures treated between January 2016 and January 2022 in Beijing Children’s Hospital.Thirty-two children who met the inclusion criteria were included in the study,with 22 males and 10 females.The mean age was(4.5±1.1)years old(range,3.1-5.9 years).The basic information,imaging data,the coronal and sagittal angulation,and related complications at the final follow-up were recorded.Results In our study,the followed up time was 12 to 36 months(mean,24 months).All patients achieved fracture healing,and the mean healing time was(5.6±1.7)weeks.There were 7 cases of residual sagittal angulation with an average of 5.9°(5°-8°),7 cases of residual coronal angulation with an average of 4.3°(3°-6°),and 2 case of lower limb length discrepancy(0.7 cm,1.0 cm).According to Flynn scoring criteria,excellent results were observed in 24 patients and satisfactory results in 8 patients,with no poor results and no unacceptable malformations.Univariate analysis showed that injury mode(χ2=4.885,P=0.053),fracture location(χ2=6.788,P=0.023)and postoperative angulation(χ2=5.788,P=0.035)affected the final residual angulation.Multivariate analysis showed that fracture location(P=0.030,OR=9.991)was an independent risk factor for final residual angulation.Conclusions Elastic intramedullary nail is an effective treatment for femoral shaft fractures in preschool children with satisfactory results and few postoperative complications.The distal and proximal third of the fracture increases the risk of angulation deformity.

关 键 词：股骨骨折 骨钉 儿童 学龄前 矫形外科手术 

分 类 号：R683.4[医药卫生—骨科学]