[1]郭美振,宿玉玺.弹性髓内钉与外固定支架治疗儿童股骨骨折的临床研究[J].第三军医大学学报,2019,41(20):2006-2011.
 GUO Meizhen,SU Yuxi.Elastic intramedullary nail fixation versus external fixation for femoral fractures in children: comparison of clinical outcomes[J].J Third Mil Med Univ,2019,41(20):2006-2011.
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弹性髓内钉与外固定支架治疗儿童股骨骨折的临床研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第20期
页码:
2006-2011
栏目:
临床医学
出版日期:
2019-10-30

文章信息/Info

Title:
Elastic intramedullary nail fixation versus external fixation for femoral fractures in children: comparison of clinical outcomes
作者:
郭美振宿玉玺
重庆医科大学附属儿童医院骨科二病房;儿童发育疾病研究教育部重点实验室;国家儿童健康与疾病临床医学研究中心;儿童发育重大疾病国家国际科技合作基地;儿科学重庆市重点实验室
Author(s):
GUO Meizhen SU Yuxi

Department of Orthopedics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics,Chongqing, 400014, China

关键词:
儿童股骨干骨折固定术弹性髓内钉外固定支架
Keywords:
pediatric femoral shaft fractures fixation elastic intramedullary nail fixation external fixation
分类号:
R658.3;R726.1;R726.8
文献标志码:
A
摘要:

目的 比较弹性髓内钉与外固定支架(Orthofix)治疗儿童股骨中段闭合性横形或短斜形骨折的疗效。方法 2009年3月至2018年8月治疗儿童股骨中段闭合性横形或短斜形骨折共67例,使用弹性髓内钉治疗34例,设置为ESIN组;使用外固定支架治疗33例,设置为EF组。对两种不同固定方式的手术时间、术中出血量、骨折愈合时间、术后膝关节功能及术后并发症等进行比较分析。结果EF组和ESIN组患者手术时间、术中出血量、骨折愈合时间分别为(110.67±54.04)min和(87.73±23.42)min,P<0.05、(152.82±192.01)mL和(48.35±48.78)mL,P<0.05、(10.83±4.22)周和(10.01±5.02)周,P>0.05。术后膝关节功能优良合计率分别为78.79%和97.06%,P<0.05;ESIN组患者的伤口感染率和取除固定物后再骨折率较EF组少(χ2=10.52,P<0.05、χ2=5.57,P<0.05),两组患者的骨折延迟愈合率无明显差异(χ2=0.64,P>0.05)。结论 针对儿童股骨中段闭合性横形或短斜形骨折的治疗,弹性髓内钉较外固定支架有很大优势,建议首选弹性髓内钉。

Abstract:

Objective To compare the therapeutic effect of elastic intramedullary nail fixation versus external fixator (Orthofix) for closed transverse or short oblique middle femoral shaft fractures in children. MethodsBetween March, 2009 and August, 2018, 67 children with closed transverse or short oblique middle femoral shaft fractures were treated with elastic intramedullary nail fixation (ESIN group, 34 cases) or external fixation (EF group, 33 cases). The operation time, intraoperative bleeding volume, fracture healing time, postoperative knee joint functions and postoperative complications were compared between the two groups. ResultsThe EF group and ESIN group showed no significant difference in the operation time (110.67±54.04 vs 87.73±23.42 min, P<0.05), intraoperative bleeding volume (152.82±192.01 vs 48.35±48.78 mL, P<0.05), or fracture healing time (10.83±4.22 vs 10.01±5.02 weeks, P>0.05). The rate of good postoperative knee joint function was significantly higher in ESIN group than in EF group (78.79% vs 97.06%, P<0.05). The incidences of wound infections and refracture of the femoral shaft were significantly lower in ESIN group than in EF group (χ2=10.52, P<0.05; χ2=5.57, P<0.05, respectively), but the incidence of delayed union did not differ significantly between the two groups. ConclusionCompared with external fixation, elastic intramedullary nail fixation achieves better clinical outcomes with reduced postoperative complications, and is therefore recommended as the primary treatment option for closed transverse or short oblique middle femoral shaft fractures in children.
 

参考文献/References:

[1]吴素英. 髓内钉置入治疗儿童股骨干骨折: 来源于SCI数据库的文献分析[J]. 中国组织工程研究, 2012, 16(30): 5670-5675.
WU S Y. The literature analysis of the intramedullary nailing implantation for the treatment of children’s femoral shaft fracture based on the Science Citation Index database[J]. Chin J Tissue Eng Res, 2012, 16(30): 5670-5675.
[2]郭永成, 邢光卫, 夏冰, 等. 弹性髓内钉与外固定架修复儿童股骨干骨折的Meta分析[J]. 中国组织工程研究, 2015, 19(31): 5072-5078.
GUO Y C, XING G W, XIA B,et al. Meta-analysis of flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures[J]. Chin J Tissue Eng Res, 2015, 19(31): 5072-5078.
[3]STURDEE S W, DAHABREH Z, TEMPLETON P A,et al. Early active treatment of femoral shaft fractures in children: A proposed protocol[J]. Inj Extra, 2007, 38(1): 29-30. DOI: 10.1016/j.injury.2006.06.092.
[4]HUBER H, ANDR G, RUMEAU F,et al. Flexible intramedullary nailing for distal femoral fractures in patients with myopathies[J]. J Child Orthop, 2012, 6(2): 119-123. DOI: 10.1007/s11832-012-0399-x.
[5]WANI MM, DAR R A, LATOO I A, et al. External fixation of pediatric femoral shaft fractures: a consecutive study based on 45 fractures[J]. J Pediatr Orthop B, 2013, 22(6): 563-570. DOI: 10.1097/BPB.0b013e32836421ce.
[6]NASCIMENTO F P, SANTILI C, AKKARI M,et al. Short hospitalization period with elastic stable intramedullary nails in the treatment of femoral shaft fractures in school children[J]. J Child Orthop, 2010, 4(1): 53-60. DOI: 10.1007/s11832-009-0227-0.
[7]王军强, 王满宜. 骨折的生物学固定[J]. 中华外科杂志, 2002, 40(7): 543-546. DOI: 10.3760/j:issn:0529-5815.2002.07.020.
WANG J Q, WANG M Y. Biological fixation of fractures[J]. Chin J Surg, 2002, 40(7): 543-546. DOI: 10.3760/j:issn:0529-5815.2002.07.020.
[8]SASEENDAR S, MENON J, PATRO D K. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hipspica casting?[J]. J Child Orthop, 2010, 4(3): 245-251. DOI: 10.1007/s11832-010-0252-z.
[9]王华明, 陈志龙, 李卫平, 等. 弹性髓内钉治疗儿童股骨干骨折钢板固定失效病例[J]. 中国组织工程研究, 2013, 17(26): 4819-4825.
WANG H M, CHEN Z L, LI W P,et al. Elastic intramedullary nail for the treatment of femoral shaft fracture in children with failed plate fixation[J]. Chin J Tissue Eng Res, 2013, 17(26): 4819-4825.
[10]KOLMERT L, WULFF K. Epidemiology and treatment of distal femoral fractures in adults[J]. Acta Orthop Scand, 1982, 53(6): 957-962.
[11]邹联银, 廖群英, 邱继明. 儿童股骨干骨折手术治疗的体会[J]. 中医临床研究, 2014, 6(23): 121-122. DOI: 10.3969/j.issn.1674-7860.2014.23.076.
ZOU L Y, LIAO Q Y, QIU J M. Experience for treating femoral shaft fracture in children[J].Clin J Chin Med, 2014, 6(23): 121-122. DOI: 10.3969/j.issn.1674-7860.2014.23.076.
[12]钟家勇, 尹松浓. AO钛制弹性髓内钉治疗小儿胫骨干骨折[J]. 医药产业资讯, 2006, 3(21): 43-44. DOI: 10.3969/j.issn.1673-7210.2006.21.031.
ZHONG J Y, YIN S N. Treatment oftibial diaphyseal fracture in children with AO synthes titanium elastic nail[J]. Med Ind Inf, 2006, 3(21): 43-44. DOI: 10.3969/j.issn.1673-7210.2006.21.031.
[13]王达辉, 陈秋, 闵若良, 等. Ender钉固定治疗小儿下肢长管状骨骨折[J]. 中华小儿外科杂志, 2006, 27(3): 140-143. DOI: 10.3760/cma.j.issn.0253-3006.2006.03.008.
WANG D H, CHEN Q, MIN R L,et al. Intramedullary stabilization of lower limb fractures with elastic Ender nails in children[J]. Chin J Pediatr Surg, 2006, 27(3): 140-143. DOI: 10.3760/cma.j.issn.0253-3006.2006.03.008.
[14]柴明祥, 王本祯, 王珊珊, 等. 三种手术方法治疗闭合性儿童股骨干骨折的比较[J]. 中国矫形外科杂志, 2018, 26(8): 692-697. DOI: 10.3977/j.issn.1005-8478.2018.08.05.
CHAI M X, WANG B Z, WANG SS, et al. Comparison of three surgical techniques for pediatric closed femoral shaft fractures[J]. Orthop J China, 2018, 26(8): 692-697. DOI: 10.3977/j.issn.1005-8478.2018.08.05.
[15]赵跃江. 儿童股骨干骨折的治疗及研究进展[D]. 石家庄: 河北医科大学, 2009.
ZHAO Y J. The treatment of children’s femoral shaft fractures and its research progress[D]. Shijiazhuang:Hebei Medical University, 2009.
[16]ROHMILLER M, DEVIN C, GLATTES R, et al. Use of reamed, locked intramedullary nails for treatment of femoral shaft fractures in skeletally immature patients[J]. Clin Immunol, 2005, 120(3): 349-356.
 

更新日期/Last Update: 2019-10-25