Sun Chao,Liu Wanlin,Wei Yishan,et al.A comparative study of potential operative risk factors for pediatric subtrochanteric fractures with titanium elastic intramedullary nail and hip locking compression plate[J].Journal of Clinical Pediatric Surgery,,19():565-572.[doi:10.3969/j.issn.1671-6353.2020.07.002]
A comparative study of potential operative risk factors for pediatric subtrochanteric fractures with titanium elastic intramedullary nail and hip locking compression plate
- CLC:
- R726.8;R683.42;R687.3+3
- Abstract:
- Objective To explore the potential operative risk factors of titanium elastic intramedullary nail versus hip locking compression plate for pediatric subtrochanteric fractures and compare the clinical efficacies of two approaches.Methods Clinical data were retrospectively analyzed for 56 children with subtrochanteric femoral fractures.The age range was 5-10 years.They were divided into closed reduction and titanium elastic intramedullary nail internal fixation plus hip spica cast fixation treatment group (A,n=34) and open reduction and hip locking compression plate internal fixation plus hip spica cast fixation group (B,n=22).Age,weight,gender,ethnicity,sideness,time from injury to operation,intraoperative blood loss,incision length,intraoperative transmission frequency,operative duration,hospitalization stay,internal fixation removal time and postoperative complications were recorded and analyzed.And imaging measurements of postoperative femoral neck shaft angle and anteversion angle and bilateral hip joint function were evaluated according to the Sanders scoring criteria.Results All 56 fractures healed well.No immediate postoperative complication occurred in neither group.The average follow-up time was 25.3(15-48) months in group A and 28.6(13-40) months in group B.The values of intraoperative blood loss,blood transfusion rate,incision length (group A was the sum of bilateral incision lengths),operative duration (excluding anesthesia,resuscitation & hip spica cast fixation time),removal time for internal fixation in group A were smaller than group B.And the differences were statistically significant (P<0.05).The intraoperative transmission frequency was significantly higher in group A than that in group B[(45.74±3.22) vs (15.52±0.54)].And the difference was statistically significant (P<0.05).No statistically significant inter-group difference existed in postoperative incision infection,irritability of implant end or length of lower extremities (P>0.05).At the last follow-up,based upon radiographic measurements,bilateral femoral neck shaft angles were as follows:group A (132.43±9.52)°,group B (128.44±13.51)°;anteversion angles:group A (21.45±5.53)°,group B (24.63±6.34)°.As compared with healthy side,neck shaft angle and anteversion angle of hip joint had no statistically significant differences (P>0.05).According to the Sanders scoring criteria,hip function was excellent (n=29),decent (n=4) and moderate (n=1) in group A with an excellent-decent rate of 97.06%;excellent (n=18),decent (n=3) and moderate (n=1) in group B with an excellent-decent rate of 95.45%;The inter-group difference was not statistically significant (P=0.92).Conclusion Titanium elastic intramedullary nail and hip locking compression plate is both safe and effective for pediatric subtrochanteric femoral fractures in children aged 5-10 years.No inter-group difference exists in long-term follow-up outcomes.However,use of titanium elastic intramedullary nail technology offers obvious advantages in terms of shorter operative duration,lesser intraoperative bleeding,lower blood transfusion rate and mini-invasive incisions.
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Memo
收稿日期:2019-05-27。
基金项目:国家临床重点专科建设费用资助项目（编号：财社[2010]305号）
通讯作者:韦宜山,Email:3276844912@qq.com