Duan Lian,Li Lianyong.Comparative study of closed reduction hip cast fixation versus elastic intramedullary nail fixation in treatment of femoral shaft fractures in preschool children[J].Journal of Clinical Pediatric Surgery,2024,(06):572-577.[doi:10.3760/cma.j.cn101785-202304020-012]
闭合复位髋人字石膏固定与弹性髓内钉固定治疗学龄前儿童股骨干骨折的对比研究
- Title:
- Comparative study of closed reduction hip cast fixation versus elastic intramedullary nail fixation in treatment of femoral shaft fractures in preschool children
- Keywords:
- Femoral Shaft Fractures; Closed Fracture Reduction; Fracture Fixation; Intramedullary; Casts; Surgical; Child; Preschool
- 摘要:
- 目的 比较闭合复位髋人字石膏固定(spica casting,SC)与弹性髓内钉(flexible intramedullary nail,FIN)固定治疗学龄前儿童股骨干骨折的临床疗效。 方法 回顾性分析2011年1月至2021年1月中国医科大学附属盛京医院小儿骨科收治的2~5岁学龄前儿童股骨干骨折患儿临床资料及随访情况,根据治疗方式分为SC组和FIN组,收集两组患儿一般资料、合并损伤、创伤严重程度、相关时间指标、住院费用及影像学情况,对比两组患儿术后并发症发生率的差异。 结果 共40例患儿纳入本研究,其中男28例、女12例,平均年龄37.73个月(24~57个月)。SC组和FIN组各20例,分别有1例(5%)和8例(40%)合并其它损伤;创伤严重程度评分(injury severity score,ISS)分别为9.0(9.0,9.0)分和10.0(9.0,13.8)分,差异有统计学意义(P=0.005);骨折愈合时间分别为(52.90±10.30)d和(53.05±10.85)d,差异无统计学意义(P=0.950);完全负重时间分别为(107.35±14.66)d和(102.50±22.70)d,差异无统计学意义(P=0.430);术后住院时间分别为1.5(1.0,2.0)d和2.0(2.0,3.0)d,差异无统计学意义(P=0.075);住院费用分别为(12 750.9±3 790.4)元和(35 196.9±4 893.2)元,差异有统计学意义(P＜0.001);SC组和FIN组骨折愈合、完全负重以及末次随访三个时间点的冠状面成角分别为6.5(4.3,8.8)°、5.0(2.0,13.0)°、3.0(2.0,5.0)°和3.0(2.0,4.0)°、2.0(2.0,3.8)°、2.0(1.0,2.0)°,差异有统计学意义(P＜0.001),三个时间点矢状面成角分别为9.5(6.3,13.0)°、8.5(5.3,11.5)°、5.0(3.3,7.8)°和4.0(2.0,5.0)°、3.0(2.0,4.0)°、2.0(2.0,3.0)°,差异有统计学意义(P＜0.001);末次随访时双下肢长度差SC组为(5.30±3.26)mm,FIN组为(7.78±5.01)mm,差异无统计学意义(P=0.073);SC组和FIN组Flynn评分优良率分别为90%和95%,差异无统计学意义(P=0.800);两组术后并发症的发生率均为10%,差异无统计学意义(P=1.000),且均为改良Clavien-Dindo分级Ⅰ、Ⅱ级并发症。 结论 在国内现有医疗模式下,SC和FIN两种方法治疗学龄前儿童股骨干骨折术后愈合过程无明显差异。与SC相比,FIN治疗花费更高,且需二次手术取出内固定。关于两种治疗方式的远期疗效以及给家庭护理带来的负担尚需进一步研究。
- Abstract:
- Objective To compare the clinical efficacy of closed reduction with spica casting (SC) versus flexible intramedullary nail (FIN) for femoral shaft fractures in preschool children.Methods A retrospective chart review was performed to identify children two to five years of age who had been treated for femoral shaft fracture.According to treatments,they were assigned into two groups of SC and FIN (n=20 each).Demographic profiles,associated injuries,injury severity,time indicators,total hospitalization expense,radiographic outcomes and complications were compared between two groups.Results A total of 40 children with a mean age of 37.73(24-57) month fulfilled the inclusion criteria.There were 28 boys and 12 girls.In SC and FIN groups,the percentage of associated injuries was 5% and 40%;Median Injury Severity Score (ISS) 9.0(9.0,9.0) and 10.0(9.0,13.8) (P=0.005);union time (52.90±10.30) and (53.05±10.85) day (P=0.950);full weight-bearing time (107.35±14.66) and (102.50±22.70) day (P=0.430);operative duration (34.95±17.63) and (102.70±27.93) min (P<0.001);median length of postoperative hospital stay 1.5(1.0,2.0) and 2.0 (2.0,3.0) day (P=0.075);total hospitalization expense (12 750.9±3 790.4) and (35 196.9±4 893.2) yuan (P<0.001);coronal angulation 6.5(4.3,8.8)°,5.0(2.0,13.0)°,3.0(2.0,5.0)°,3.0(2.0,4.0)°,2.0(2.0,3.8)°,2.0(1.0,2.0)° at fracture union,full weight bearing and last follow-up (P<0.001);sagittal angulation 9.5(6.3,13.0)°,8.5(5.3,11.5)°,5.0(3.3,7.8)°,4.0(2.0,5.0)°,3.0(2.0,4.0)°,2.0(2.0,3.0)°(P<0.001).At the last follow-up,limb length discrepancy was (5.30±3.26) in SC group and (7.78±5.01) mm in FIN group (P=0.073);excellent/decent rate of Flynn score 90% and 95%.And the difference was not statistically significant (P=0.800).The incidence of postoperative complications was 10% in both groups.All complications were classified as Clavien-Dindo grade-Ⅰ/Ⅱ.Conclusions No significant difference exists in short-term healing process between two treatment modes under current domestic medical model.As compared with SC,FIN is more expensive and requires a second surgery for removing nails.Long-term efficacy of two treatment methods and family burden of care should be further examined in the future.
参考文献/References:
[1] Engstr?m Z,Wolf O,Hailer YD.Epidemiology of pediatric femur fractures in children:the Swedish Fracture Register[J].BMC Musculoskelet Disord,2020,21(1):796.DOI:10.1186/s12891-020-03796-z.
[2] Roaten JD,Kelly DM,Yellin JL,et al.Pediatric femoral shaft fractures:a multicenter review of the AAOS clinical practice guidelines before and after 2009[J].J Pediatr Orthop,2019,39(8):394-399.DOI:10.1097/BPO.0000000000000982.
[3] Jevsevar DS,Shea KG,Murray JN,et al.AAOS clinical practice guideline on the treatment of pediatric diaphyseal femur fractures[J].J Am Acad Orthop Surg,2015,23(12):e101.DOI:10.5435/JAAOS-D-15-00523.
[4] Rapp M,Kaiser MM,Grauel F,et al.Femoral shaft fractures in young children (<5 years of age):operative and non-operative treatments in clinical practice[J].Eur J Trauma Emerg Surg,2016,42(6):719-724.DOI:10.1007/s00068-015-0570-4.
[5] Alluri RK,Sabour A,Heckmann N,et al.Increasing rate of surgical fixation in four-and five-year-old children with femoral shaft fractures[J].J Am Acad Orthop Surg,2019,27(1):e24-e32.DOI:10.5435/JAAOS-D-17-00064.
[6] Barnett SA,Song BM,Yan J,et al.Intraoperative burden of flexible intramedullary nailing and spica casting for femur fractures in young children[J].J Pediatr Orthop,2021,41(7):e499-e505.DOI:10.1097/BPO.0000000000001857.
[7] Assaghir Y.The safety of Titanium elastic nailing in preschool femur fractures:a retrospective comparative study with spica cast[J].J Pediatr Orthop B,2013,22(4):289-295.DOI:10.1097/BPB.0b013e328360266e.
[8] Baker SP,O’Neill B,Haddon WJr,et al.The injury severity score:a method for describing patients with multiple injuries and evaluating emergency care[J].J Trauma,1974,14(3):187-196.
[9] Flynn JM,Garner MR,Jones KJ,et al.The treatment of low-energy femoral shaft fractures:a prospective study comparing the"walking spica"with the traditional spica cast[J].J Bone Joint Surg Am,2011,93(23):2196-2202.DOI:10.2106/JBJS.J.01165.
[10] Clavien PA,Strasberg SM.Severity grading of surgical complications[J].Ann Surg,2009,250(2):197-198.DOI:10.1097/SLA.0b013e3181b6dcab.
[11] Ramo BA,Martus JE,Tareen N,et al.Intramedullary nailing compared with spica casts for isolated femoral fractures in four and five-year-old children[J].J Bone Joint Surg Am,2016,98(4):267-275.DOI:10.2106/JBJS.O.00706.
[12] Donati F,Mazzitelli G,Lillo M,et al.Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age[J].World J Orthop,2017,8(2):156-162.DOI:10.5312/wjo.v8.i2.156.
[13] Kramer EJ,Shearer D,Morshed S.The use of traction for treating femoral shaft fractures in low-and middle-income countries:a systematic review[J].Int Orthop,2016,40(5):875-883.DOI:10.1007/s00264-015-3081-3.
[14] Gordon JE,Anderson JT,Schoenecker PL,et al.Treatment of femoral fractures in children aged two to six[J].Bone Joint J,2020,102-B(8):1056-1061.DOI:10.1302/0301-620X.102B8.BJJ-2019-1060.R3.
[15] Beaty JH,Kasser JR,Kasser JR,et al.Rockwood and Wilkins’ fractures in children[M].7th ed.Philadelphia:Wolters Kluwer/Lippincott,Williams & Wilkins,2010:1076.
[16] Gross I,Hashavya S,Rogachev S,et al.Orthotic hip brace as an alternative for treatment of femoral fractures in children under the age of 3 years:a retrospective study[J].J Pediatr Orthop B,2023,32(3):287-291.DOI:10.1097/BPB.0000000000001000.
[17] Cintean R,Eickhoff A,Pankratz C,et al.ESIN in femur fractures in children under 3:is it safe?[J].Eur J Trauma Emerg Surg,2022,48(5):3401-3407.DOI:10.1007/s00068-022-01965-4.
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备注/Memo
收稿日期:2023-04-06。
通信作者:李连永,Email:loyo_ldy@163.com