Hou Limin,Jiang Fei,Qiao Fei,et al.Efficacy of elastic stable intramedullary nailing for school-age children with long spiral tibial shaft fractures[J].Journal of Clinical Pediatric Surgery,2023,22(04):373-378.[doi:10.3760/cma.j.cn101785-202111042-014]
弹性髓内钉治疗学龄期儿童胫骨干长螺旋形骨折的疗效分析
- Title:
- Efficacy of elastic stable intramedullary nailing for school-age children with long spiral tibial shaft fractures
- Keywords:
- Tibial Fractures; Fracture Fixation; Intramedullary; Treatment Outcome; Child
- 摘要:
- 目的 探讨弹性髓内钉(elastic stable intramedullary nailing,ESIN)治疗学龄期儿童胫骨干长螺旋形骨折的临床疗效。方法 回顾性分析2014年10月至2019年10月大连市妇女儿童医疗中心(集团)小儿骨科采用弹性髓内钉治疗的113例学龄期儿童胫骨干骨折病例资料。根据骨折类型分为长螺旋形骨折组(37例37侧)、横形/短斜形骨折组(76例76侧)。比较两组患儿基本资料、手术情况、住院时间、治疗效果以及术后并发症情况。结果 两组患儿年龄、性别、骨折位置及左/右侧别、是否伴有腓骨骨折、手术时间、术中出血量、完全负重时间、髓内钉取出时间、总住院时间及治疗费用比较,差异均无统计学意义(P>0.05)。根据Flynn评分标准评估临床疗效,两组疗效差异也无统计学意义(P>0.05)。长螺旋形骨折组有1例(1侧)发生并发症(1/37,2.70%),横形/短斜形骨折组共有3例(3侧)发生并发症(3/76,3.94%),但差异无统计学意义(P>0.05)。结论 弹性髓内钉治疗学龄期儿童胫骨干长螺旋形骨折疗效确切,术后并发症的发生率较横形/短斜形骨折无明显增加。
- Abstract:
- Objective To explore the clinical efficacy of elastic stable intramedullary nailing (ESIN) for long spiral tibial shaft fractures in school-age children.Methods From October 2014 to October 2019,retrospective analysis of tibial shaft fractures was conducted for 7-12-year-old school-age children using elastic intramedullary nails.According to fracture type,they were divided into two groups of long spiral fracture (n=37) and horizontal/short oblique fracture (n=76).Basic profiles,intraoperative findings,hospitalization length,treatment outcomes and postoperative complications of two groups were compared.Results No significant inter-group differences existed in gender,age,sideness,injury cause,fracture site,fibula fracture or not,operative duration,intraoperative blood loss,hospitalization length or medical expenditure (P>0.05).No significant inter-group difference existed in Flynn efficacy evaluation of ESIN (P>0.05).There was no significant inter-group difference in fracture healing time,complete weight bearing time or intramedullary nail removal time (P>0.05).Complication rate was 2.70% in long spiral fracture group and 3.94% in transverse/short oblique fracture group.There was no statistically significant inter-group difference (P>0.05).Conclusion ESIN has an excellent therapeutic efficacy for school-age children with long spiral tibial shaft fractures.With minimal invasiveness,there is a low risk of postoperative complications.It is worthy of widespread clinical applications.
参考文献/References:
[1] 水小龙,孔建中,潘骏.弹性髓内钉治疗儿童胫骨骨折的临床疗效分析[J].中华小儿外科杂志,2007,28(9):498-500.DOI:10.3760/cma.j.issn.0253-3006.2007.09.014. Shui XL,Kong JZ,Pan J.Efficacies of elastic intramedullary nailing for children with tibial fracture[J].Chin J Pediatr Surg,2016,28(9):498-500.DOI:10.3760/cma.j.issn.0253-3006.2007.09.014.
[2] Khaffaf RMN,Altaweel AH.Comparative study between the elastic nail versus hip Spica cast in early treatment of pediatric femoral shaft fractures[J].Open J Orthop,2016,6(9):259-267.DOI:10.4236/ojo.2016.69034.
[3] Galano GJ,Vitale MA,Kessler MW,et al.The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population[J].J Pediatr Orthop,2005,25(1):39-44.DOI:10.1097/00004694-200501000-00010.
[4] 邱继明,陈春华.弹性髓内针治疗儿童四肢长骨骨折33例[J].临床小儿外科杂志,2013,12(3):248-249.DOI:10.3969/j.issn.1671-6353.2013.03.028. Qiu JM,Chen CH.Elastic intramedullary nailing for children with long bone fracture[J].J Clin Ped Sur,2013,12(3):248-249.DOI:10.3969/j.issn.1671-6353.2013.03.028.
[5] 吴海艺,梁龙芳,裴新红.弹性髓内钉单骨固定治疗儿童前臂双骨折疗效的Meta分析[J].临床小儿外科杂志,2019,18(11):941-947.DOI:10.3969/j.issn.1671-6353.2019.11.009. Wu HY,Liang LF,Pei XH.Efficacy of elastic stable intramedullary nailing single bone fixation for children with bilateral forearm bone fractures:a Meta-analysis[J].J Clin Ped Sur,2019,18(11):941-947.DOI:10.3969/j.issn.1671-6353.2019.11.009.
[6] Flynn JM,Hresko T,Reynolds RA,et al.Titanium elastic nails for pediatric femur fractures:a multicenter study of early results with analysis of complications[J].J Pediatr Orthop,2001,21(1):4-8.DOI:10.1097/00004694-200101000-00003.
[7] Joeris A,Lutz N,Wicki B,et al.An epidemiological evaluation of pediatric long bone fractures-a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals[J].BMC Pediatr,2014,14:314.DOI:10.1186/s12887-014-0314-3.
[8] Ligier JN,Metaizeau JP,Prévot J.Closed flexible medullary nailing in pediatric traumatology[J].Chir Pediatr,1983,24(6):383-385.
[9] Karaman I,Halici M,Kafadar IH,et al.Mid-term results of the elastic intramedullary nailing in paediatric long bone shaft fractures:a prospective study of 102 cases[J].J Pediatr Orthop B,2014,23(3):212-220.DOI:10.1097/01.bpb.0000444460.95927.05.
[10] Heo J,Oh CW,Park KH,et al.Elastic nailing of tibia shaft fractures in young children up to 10 years of age[J].Injury,2016,47(4):832-836.DOI:10.1016/j.injury.2015.10.024.
[11] Swindells MG,Rajan RA.Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis:a systematic review[J].J Child Orthop,2010,4(1):45-51.DOI:10.1007/s11832-009-0223-4.
[12] Debnath S,Debbarma S,Sarkar A.Titanium elastic nailing osteosynthesis for diaphyseal tibial fracture in pediatr?c age group-our experience[J].Indian J Appl Res,2017,7(2):52-53.DOI:10.12669/pjms.346.16297.
[13] Kc KM,Acharya P,Sigdel A.Titanium elastic nailing system (TENS) for tibia fractures in children:functional outcomes and complications[J].JNMA J Nepal Med Assoc,2016,55(204):55-60.DOI:10.1097/00004694-1000-00010.
[14] Zeng SD,Deng HS,Zhu TF,et al.Calcaneal skeletal traction versus elastic intramedullary nailing of displaced tibial shaft fractures in children[J].Injury,2021,52(4):849-854.DOI:10.1016/j.injury.2020.10.035.
[15] Müller ME,Koch P,Nazarian S,et al.The comprehensive classification of fractures of long bones[M].Berlin:Springer,1990.DOI:10.1007/978-3-642-61261-9.
[16] Patel NK,Horstman J,Kuester V,et al.Pediatric tibial shaft fractures[J].Indian J Orthop,2018,52(5):522-528.DOI:10.4103/ortho.IJOrtho_486_17.
[17] Sankar WN,Jones KJ,David Horn B,et al.Titanium elastic nails for pediatric tibial shaft fractures[J].J Child Orthop,2007,1(5):281-286.DOI:10.1007/s11832-007-0056-y.
[18] Onta PR,Thapa P,Sapkota K,et al.Outcome of diaphyseal fracture of tibia treated with flexible intramedullary nailing in pediatrics age group; a prospective study[J].Am J Public Health Res,2015,3(4A):65-68.DOI:10.12691/ajphr-3-4A-14.
[19] Rickert KD,Hosseinzadeh P,Edmonds EW.What’s new in pediatric orthopaedic trauma:the lower extremity[J].J Pediatr Orthop,2018,38(8):e434-e439.DOI:10.1097/BPO.0000000000001209.
[20] Uluda? A,Tosun HB.Treatment of unstable pediatric tibial shaft fractures with titanium elastic nails[J].Medicina (Kaunas),2019,55(6):266.DOI:10.3390/medicina55060266.
[21] Vallamshetla VRP,De Silva U,Bache CE,et al.Flexible intramedullary nails for unstable fractures of the tibia in children.An eight-year experience[J].J Bone Joint Surg Br,2006,88(4):536-540.DOI:10.1302/0301-620X.88B4.17363.
[22] Gordon JE,O’Donnell JC.Tibia fractures:what should be fixed?[J].J Pediatr Orthop,2012,32(Suppl 1):S52-S61.DOI:10.1097/BPO.0b013e318254c7be.
[23] 陈伟,李佳,张英泽.AAOS《儿童股骨干骨折治疗指南》解读[J].中华外科杂志,2017,55(1):44-48.DOI:10.3760/cma.j.issn.0529-5815.2017.01.012. Chen W,Li J,Zhang YZ.Interpretation of American Academy of Orthopedic Surgeons’ Clinical Practice Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures[J].Chin J Surg,2017,55(1):44-48.DOI:10.3760/cma.j.issn.0529-5815.2017.01.012.
[24] 李伟元,孙卫强,刘坤,等.手法复位结合改良入路经皮弹性髓内钉内固定治疗老年人肱骨外科颈骨折的临床观察[J].中华解剖与临床杂志,2019,24(4):410-414.DOI:10.3760/cma.j.issn.2095-7041.2019.04.018. Li WY,Sun WQ,Liu K,et al.Clinical research on elderly patients with humeral surgical neck fractures by manipulative reduction and improved approach of intramedullary fixation with titanium elastic nails[J].Chin J Anat Clin,2019,24(4):410-414.DOI:10.3760/cma.j.issn.2095-7041.2019.04.018.
[25] 杨明,武理国,马一平,等.微创双弹性髓内钉治疗儿童桡骨下段骨折[J].中华手外科杂志,2017,33(3):174-175.DOI:10.3760/cma.j.issn.1005-054X.2017.03.006. Yang M,Wu LG,Ma YP,et al.Mini-invasive titanium elastic nails for distal radia fracture[J].Chin J Hand Surg,2017,33(3):174-175.DOI:10.3760/cma.j.issn.1005-054X.2017.03.006.
[26] O’Brien T,Weisman DS,Ronchetti P,et al.Flexible titanium nailing for the treatment of the unstable pediatric tibial fracture[J].J Pediatr Orthop,2004,24(6):601-609.DOI:10.1097/00004694-200411000-00001.
[27] Chen YN,Lee PY,Chang CH,et al.Computational comparison of tibial diaphyseal fractures fixed with various degrees of prebending of titanium elastic nails and with and without end caps[J].Injury,2016,47(10):2339-2346.DOI:10.1016/j.injury.2016.07.001.
[28] Gordon JE,Gregush RV,Schoenecker PL,et al.Complications after titanium elastic nailing of pediatric tibial fractures[J].J Pediatr Orthop,2007,27(4):442-446.DOI:10.1097/01.bpb.0000271333.66019.5c.
[29] 李辽波,张晓瑞,刘鹏.闭合弹性髓内钉微创技术在儿童股骨干骨折患者中的疗效观察及对术后软组织肿痛的影响研究[J].临床医学研究与实践,2017,2(36):64-65.DOI:10.19347/j.cnki.2096-1413.201736030. Li LB,Zhang XR,Liu P.Clinical effect observation of closed titanium elastic nails in children with femoral shaft fractures and its effect on postoperative soft tissue swelling and pain[J].Clin Res Pract,2017,2(36):64-65.DOI:10.19347/j.cnki.2096-1413.201736030.
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备注/Memo
收稿日期:2021-11-21。
通讯作者:蒋飞,Email:jf2299@163.com