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-  2015 

闭合与切开复位弹性髓内钉内固定治疗儿童股骨粗隆下骨折疗效比较

DOI: doi:10.7507/1002-1892.20150289

Keywords: 股骨粗隆下骨折, 弹性髓内钉, 内固定, 闭合复位, 切开复位, 儿童

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Abstract:

目的比较闭合复位与切开复位弹性髓内钉内固定治疗儿童股骨粗隆下骨折的疗效。 方法回顾性分析2010年1月-2014年1月采用弹性髓内钉内固定加石膏外固定术治疗并获随访的股骨粗隆下骨折患儿22例,其中采用闭合复位(A组)12例,小切口切开复位(B组)10例。两组患儿性别、年龄、侧别、致伤原因、骨折分型、合并伤及受伤至手术时间等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组手术时间、术中出血量、骨折愈合时间和并发症发生情况,根据Flynn等提出的髓内钉治疗股骨骨折评分标准评价术后患肢功能。 结果A组术中出血量少于B组,但手术时间长于B组,比较差异均有统计学意义(P<0.05)。两组患儿均获随访,随访时间12~36个月,平均14.9个月。除B组1例患儿切口延期愈合外,其余患儿均无深部组织感染以及其他严重并发症发生。两组骨折愈合时间比较差异无统计学意义(t=-1.006,P=0.327)。A组1例患儿出现内翻成角10°、患肢短缩1.8 cm,B组1例患儿出现矢状面向后成角15°、患肢短缩2 cm。所有患儿行走及髋、膝活动功能均无异常。末次随访时,根据Flynn等提出的髓内钉治疗股骨骨折评分标准,A组获优8例、良4例,B组优6例、良4例,两组比较差异无统计学意义(χ2=0.041,P=0.956)。 结论闭合复位与小切口切开复位弹性髓内钉内固定加石膏外固定术治疗儿童股骨粗隆下骨折均可获得满意疗效,疗效无明显差异。若术中闭合复位困难,建议及早切开复位

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