Hertlein H, Aidelsburger P, Huber A, Hartl W H, Andress H J
Abteilung für Unfall- und Wiederherstellungschirurgie, Städtischen Krankenhauses München-Harlaching.
Zentralbl Chir. 2000;125(9):756-62. doi: 10.1055/s-2000-10659.
Elastic intramedullary nailing represents a new surgical concept in the treatment of unstable shaft fractures in children. The present case control study wanted to examine the superiority of intramedullary nailing in comparison to conservative therapeutic concepts which had been applied so far. 13 children with forearm fractures who were treated initially by conservative measures were compared to 13 other children who received a primary intramedullary nailing. With femoral fractures, 12 children were included in each group. In each patient pair age, type and localisation of the fracture were comparable. During the observation period (until the termination of final therapeutic measures or until the third year after injury) we examined clinical variables and subjective findings. Both therapeutic concepts led to comparably good functional results. Also subjective judgement of the therapeutic success did not differ between groups. However, with intramedullary nailing of shaft fractures of the femur the mean hospital length of stay (7.0 +/- 3.5 days) was significantly shorter than with initial conservative treatment (36.5 +/- 2.2 days, P < 0.05). Irrespective of the localisation of the fracture intramedullary nailing required significantly less x-ray examinations during the observation period. These results suggest intramedullary nailing to be the procedure of choice to treat unstable forearm and femoral fractures in children.
弹性髓内钉是治疗儿童不稳定骨干骨折的一种新的外科理念。本病例对照研究旨在探讨髓内钉与目前应用的保守治疗理念相比的优越性。将13例最初采用保守治疗的前臂骨折患儿与另外13例接受一期髓内钉治疗的患儿进行比较。对于股骨骨折，每组纳入12例患儿。每对患者的年龄、骨折类型和部位具有可比性。在观察期内（直至最终治疗措施结束或受伤后第三年），我们检查了临床变量和主观结果。两种治疗理念均取得了相当好的功能结果。两组之间对治疗成功的主观判断也没有差异。然而，股骨骨干骨折采用髓内钉治疗的平均住院时间（7.0±3.5天）明显短于最初的保守治疗（36.5±2.2天，P<0.05）。无论骨折部位如何，髓内钉治疗在观察期内所需的X线检查明显较少。这些结果表明，髓内钉是治疗儿童不稳定前臂和股骨骨折的首选方法。
