Chen Jinchen,Chen Shunyou,Pan Yuancheng.Analysis of screw depth for therapeutic efficacy of Delbet type Ⅱ/Ⅲ femoral neck fractures in children[J].Journal of Clinical Pediatric Surgery,2020,19(07):573-578.[doi:10.3969/j.issn.1671-6353.2020.07.003]
螺钉置入深度对Delbet Ⅱ型、Ⅲ型儿童股骨颈骨折治疗效果的影响研究
- Title:
- Analysis of screw depth for therapeutic efficacy of Delbet type Ⅱ/Ⅲ femoral neck fractures in children
- 分类号:
- R726.8;R683.42;R687.3+2
- 摘要:
- 目的 探讨螺钉置入深度对Delbet Ⅱ型、Ⅲ型儿童股骨颈骨折治疗效果的影响。方法 回顾性分析2011年6月至2019年4月厦门大学附属福州第二医院使用螺钉固定的Delbet Ⅱ型、Ⅲ型股骨颈骨折患儿临床资料。将股骨近端分成6个区域，内固定跨度的定义为内固定末端的分区数值减去骨折线的分区数值。记录年龄、复位方式、复位质量、骨折线分区位置、内固定末端位置、内固定跨度、末次随访是否出现骨折移位、骨折不愈合、股骨头坏死、髋内翻畸形及股骨颈短缩情况。结果 共37例纳入本研究，其中男19例，女18例，年龄4~16岁，平均10.5岁，平均随访时间23.4个月。12例骨折线位于1区，20例位于2区，5例位于3区，4区和5区无骨折发生，骨折线位于3区的患儿年龄明显大于骨折线位于1区和2区的患儿（P<0.05）。所有内固定跨度至少为2个分区，通常为3个分区。有6例（16.2%）出现股骨头缺血坏死，股骨头缺血坏死的发生与内固定末端的分区位置没有关联性（P>0.05）。其他并发症（如骨折端移位、骨不连、髋内翻、股骨颈短缩）均伴随股骨头坏死的发生。结论 大部分儿童Delbet Ⅱ型、Ⅲ型股骨颈骨折骨折线位于1区和2区，且年龄相对较小。至少2个区域的内固定跨度即可实现骨折的稳定性。螺钉是否通过骺板与股骨头缺血性坏死的发生并无因果关系。
- Abstract:
- Objective To explore the therapeutic efficacy of screw depth for Delbet type Ⅱ/Ⅲ femoral neck fractures in children.Methods Retrospective analysis was performed for clinical data of screw-treated children with Delbet type Ⅱ/Ⅲ femoral neck fractures from June 2011 to April 2019.Proximal femur was divided into six zones and the term "internal fixation span" defined as zone number of internal fixation end minus zone number of fracture line.Operative age,open versus close reduction,quality of reduction,internal fixation end zone,fracture line zone,internal fixation span,displacement,nonunion,avascular necrosis,coxa vara and femural neck shortening were analyzed.Results A total of 37 children were recruited.There were 19 boys and 18 girls with a mean age of 10.5(4-16) years and a mean follow-up period of 23.4 months.Fracture lines were located in zone 1 (n=12),zone 2 (n=20),zone 3 (n=5) and zone 4/5 (n=0).The children whose fracture lines located in zone 3 was significantly older than those in zone 1/2 (P<0.05).Internal fixation span was at least 2 zones in all children.Six cases (16.2%) had avascular necrosis and avascular necrosis had no relationship with zone end of internal fixation (P>0.05).The complications of displacement,nonunion,coxa vara and femoral neck shortening were all accompanied by avascular necrosis.Conclusion Most cases of Delbet type Ⅱ/Ⅲ femoral neck fractures are located in zone 1/2 at a relatively young age.And internal fixation span at least 2 zones can achieve stability.No obvious relationship exists between transphyseal internal fixation and avascular necrosis.
参考文献/References:
1 Patterson JT,Tangtiphaiboontana J,Pandya NK,et al.Management of pediatric femoral neck fracture[J].J Am Acad Orthop Sur,2018,26(12):411-419.DOI:10.5435/JAAOS-D-16-00362.
2 Hughes LO,Beaty JH.Fractures of the head and neck of the femur in children[J].J Bone Joint Surg Am,1994,76(2):283-292.DOI:10.2106/00004623-199402000-00019.
3 Hajdu S,Oberleitner G,Schwendenwein E,et al.Fractures of the head and neck of the femur in children:an outcome study[J].Int Orthop,2010,35(6):883-888.DOI:10.1007/s00264-010-1039-z.
4 Dial B,Lark R.Pediatric proximal femur fractures[J].J Orthop,2018,15(2):529-535.DOI:10.1016/j.jor.2018.03.039.
5 Panigrahi R,Sahu B,Mahapatra AK,et al.Treatment analysis of paediatric femoral neck fractures:a prospective multicenter therapeutic study in Indian scenario[J].Int Orthop,2015,39(6):1121-1127.DOI:10.1007/s00264-015-2677-y.
6 Song K.Displaced fracture of the femoral neck in children:open versus closed reduction[J].J Bone Joint Surg Br,2010,92(8):1148-1151.DOI:10.1302/0301-620X.92B8.24482.
7 Colonna PC.Fracture of the neck of the femur in children[J].Am J Surg,1929,6(6):793-797.DOI:10.1016/S0002-9610(29)90726-1.
8 Togrul E,Bayram H, Gulsen M,et al.Fractures of the femoral neck in children:long-term follow-up in 62 hip fractures[J].Injury,2005,36(1):123-130.DOI:10.1016/j.injury.2004.04.010.
9 Moon ES,Mehlman CT.Risk factors for avascular necrosis after femoral neck fractures in children:25 Cincinnati cases and meta-analysis of 360 cases[J].J Orthop Trauma,2006,20(5):323-329.DOI:10.1097/00005131-200605000-00005.
10 Shrader MW,Jacofsky DJ,Stans AA,et al.Femoral neck fractures in pediatric patients:30 years experience at a level 1 trauma center[J].Clin Orthop Relat Res,2007,454:169-173.DOI:10.1097/01.blo.0000238794.82466.3d.
11 Eberl R,Singer G,Ferlic P,et al.Post-traumatic coxa vara in children following screw fixation of the femoral neck[J].Acta Orthop,2010,81(4):442-445.DOI:10.3109/17453674.2010.501744.
12 Spence D,Di Mauro JP,Miller PE,et al.Osteonecrosis after femoral neck fractures in children and adolescents:analysis of risk factors[J].J Pediatr Orthop,2016,36(2):111-116.DOI:10.1097/BPO.0000000000000424.
13 Stone JD,Hill MK,Pan Z,et al.Open reduction of pediatric femoral neck fractures reduces osteonecrosis risk[J].Orthopedics,2015,38(11):e983-e990.DOI:10.3928/01477447-20151020-06.
14 Yeranosian M,Horneff JG,Baldwin K,et al.Factors affecting the outcome of fractures of the femoral neck in children and adolescents:a systematic review[J].Bone Joint J,2013,95-B(1):135-142.DOI:10.1302/0301-620X.95B1.30161.
15 Wang WT,Li YQ,Guo YM,et al.Risk factors for the development of avascular necrosis after femoral neck fractures in children:a review of 239 cases[J].Bone Joint J,2019,101-B(9):1160-1167.DOI:10.1302/0301-620X.101B9.BJJ-2019-0275.R1.
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备注/Memo
收稿日期:2020-05-12。
基金项目:福建省卫生计生科研人才培养医学创新课题项目（编号：2017-CX-46）
通讯作者:陈顺有,Email:csy508@163.com