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,2020,19(07):565-572.[doi:10.3969/j.issn.1671-6353.2020.07.002]
应用弹性髓内针与髋部锁定加压钢板治疗儿童股骨转子下骨折的手术潜在风险因素对比研究
- Title:
- A comparative study of potential operative risk factors for pediatric subtrochanteric fractures with titanium elastic intramedullary nail and hip locking compression plate
- 分类号:
- R726.8;R683.42;R687.3+3
- 摘要:
- 目的 分析采用弹性髓内针与髋部锁定加压钢板行儿童股骨转子下骨折手术过程中的潜在风险因素，并对比两种方法的临床疗效。方法 回顾性分析56例儿童股骨转子下骨折患儿临床资料。患儿年龄5~10岁，依据治疗方式的不同分成：闭合复位弹性髓内钉固定联合髋人字石膏外固定治疗组（A组，34例）和切开复位髋部锁定加压钢板固定联合髋人字石膏外固定治疗组（B组，22例）。对比两组患儿的年龄、体重、性别、民族、侧别、受伤至手术的时间、术中出血量、切口长度、术中透射次数、术中耗时、住院时间、内固定取出时间及术后并发症等资料；对术后股骨颈干角和前倾角进行影像学评估，按Sanders评分原则实施双侧髋关节功能评定。结果 56例骨折全部愈合良好，两组均未发生即刻术后并发症。A组平均随访25.3个月（15~48个月），B组平均随访28.6个月（13~40个月）。A组术中出血量、输血率、切口长度（A组为双侧切口长度之和）、术中耗时（不包括麻醉、复苏及髋人字石膏固定所耗时间）、内置物取出时间的值均小于B组，差异有统计学意义（P<0.05）；而术中透射次数A组为（45.74±3.22）次，显著高于B组[（15.52±0.54）次]，差异具有统计学意义（P<0.05）。两组术后切口感染、内置物末端激惹率、双下肢长度比较差异均无统计学意义（P>0.05）。末次随访时根据影像学评估，双侧股骨颈干角分别为：A组（132.43±9.52）°，B组（128.44±13.51）°；前倾角分别为：A组（21.45±5.53）°，B组（24.63±6.34）°。两组患侧髋关节颈干角及前倾角与健侧相比，差异均无统计学意义（P>0.05）。根据Sanders评分标准评价患侧髋关节功能：A组中优29例、良4例、中1例，优良率97.06%；B组中优18例、良3例、中1例，优良率95.45%；差异无统计学意义（P=0.92）。结论 弹性髓内针与髋部锁定加压钢板是治疗5~10岁儿童股骨转子下骨折安全有效的方法。两种治疗方法的远期随访结果没有差异，但是使用弹性髓内针技术在缩短手术时间、减少术中出血、降低输血率以及微创切口等方面优势明显。
- 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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备注/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