Nan Guoxin,Xu Weisen,Cai Wenquan,et al.Experience of treating femoral neck fractures in children through a direct anterior approach[J].Journal of Clinical Pediatric Surgery,2024,(04):361-366.[doi:10.3760/cma.j.cn101785-202403060-011]
经正前方切口入路治疗儿童股骨颈骨折的疗效分析
- Title:
- Experience of treating femoral neck fractures in children through a direct anterior approach
- Keywords:
- Femoral Neck Fractures; Surgical Procedures; Operative; Fracture Fixation; Internal; Treatment Outcome; Child
- 摘要:
- 目的 探讨一种简单易行、创伤小的儿童股骨颈骨折手术入路方法,并初步评估其疗效。 方法 回顾性分析2017年2月至2023年1月广东医科大学东莞市儿童医院小儿骨科及重庆医科大学附属儿童医院骨科采取切开复位、加压螺钉或克氏针固定治疗的儿童股骨颈骨折患儿临床资料,共13例(14侧,其中1例合并癫痫患儿两侧股骨颈先后相隔6个月发生骨折),男10例、女3例;年龄3.2~8.2岁,平均年龄6.5岁。Delbet分型:Ⅰ型2例(2侧),Ⅱ型9例(10侧),Ⅲ型2例(2侧)。术前均存在明显骨折移位或成角畸形。手术在全身麻醉下进行,于C臂下精准定位,采用正前方切口入路(direct anterior approach,DAA),切开皮肤、皮下组织,钝性游离股直肌近端外侧,并将股直肌近端向内侧牵开,显露髋关节囊前部。对于Ⅱ、Ⅲ型骨折,打开关节囊,助手牵引,直视下复位,打入导针确定无误后打入2枚直径4.0 mm的空心加压螺钉固定;对于Ⅰ型骨折,采用3~4枚直径2.0 mm的克氏针固定。术后髋人字支具或石膏固定6周。术后3个月内患侧避免负重,每个月随访1次,术后6个月拆除内固定。收集患儿切口长度、手术时间、术中出血量、复位以及随访情况。 结果 患儿平均切口长度3.2 cm,术中未切断任何肌肉,平均手术时间36 min,术中平均出血量12.3 mL。术后X线片均显示解剖复位。13例均获随访,拆除内固定时间为术后6~12个月,平均为术后6.8个月。1例Ⅰ型骨折患儿拔出克氏针后,MRI发现股骨头缺血坏死。 结论 DAA治疗儿童股骨颈骨折,骨折部位暴露清楚,创伤小,不破坏前方肌肉的完整性,术后功能恢复快,并发症少,是治疗儿童股骨颈骨折的一种简单易行的手术入路方法。
- Abstract:
- Objective To explore a simple and mini-invasive surgical approach for femoral neck fracture in children. Methods From February 2017 to January 2023,retrospective review was performed for the relevant clinical data of 13 children with femoral neck fractures undergoing incisional reduction,compression screw or Kirschner pin fixation at Chongqing Children’s Hospital and Dongguan Children’s Hospital.There were a total of 14 sides.One epileptic child had bilateral femoral neck fractures occurring sequentially 6 months apart.There were 10 boy and 3 girls with a mean age of 6.5(3.2-8.2) year.Delbet type was Ⅰ (n=2),Ⅱ (n=9,10 sides) and Ⅲ (n=2).All cases exhibited significant fracture displacement or angular deformity pre-operation.Operation was performed under general anesthesia.After location was located under a C-arm,target location was marked and direct anterior approach (DAA) adopted.After incising skin and subcutaneous fat,proximal lateral side of rectus femoris muscle was bluntly dissected and proximal end of muscle retracted medially,exposing anterior part of hip joint capsule.For type Ⅰ/Ⅱ fracture,joint capsule was opened and assisted traction plus reduction were performed under a direct vision.Then after inserting guide wires and confirming a correct position,two hollow compression screws with a diameter of 4.0 mm were used for fixation.For type Ⅰ fractures,3-4 Kirschner needle with a diameter of 2.0 mm was utilized for fixation.After surgery,they were immobilized with a hip brace or cast for 6 weeks and then removed.At Month 3 post-operation,weight-bearing activities at affected side were avoided and monthly follow-ups conducted.At Month 6 post-operation,internal fixation was removed and MRI performed for eliminating the possibility of avascular necrosis of femoral head.Collect information on incision length,operative time,intraoperative bleeding,reduction and complications in all patients. Results The incision length ranged from 3.0 to 3.5 cm with a mean length of 3.2 cm.No muscle tissue was incised intraoperatively.Average operative duration was 36(33-42) min.Intraoperative hemorrhage had a mean volume of 12.3(12-20) mL.Postoperative radiography confirmed anatomical realignment in all cases.Internal fixation was removed at a mean time of 6.8(6-12) month.One child of type Ⅰ fracture resulting in ischemic necrosis of the femoral head was identified through MRI after Kirschners pin removal. Conclusions DAA is suitable for treating pediatric femoral neck fractures.This approach may provide a distinct exposure of fracture site,cause mini-trauma and does not disrupt the integrity of anterior muscles.Allowing for fast postoperative functional recovery,it has a low incidence of complications,making it a simple and feasible surgical approach for femoral neck fractures.
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备注/Memo
收稿日期:2023-08-08。
通讯作者:南国新,Email:ngx1215@126.com