Flynn John M, Luedtke Lael, Ganley Theodore J, Pill Stephan G
Division of Orthopedics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA.
Am J Orthop (Belle Mead NJ). 2002 Feb;31(2):71-4.
Traditionally, the treatment of choice in managing pediatric femur fractures has been traction and casting. Newer methods have focused on earlier mobility and shorter hospitalization. Use of retrograde titanium elastic nails (TENs) can quicken stabilization while allowing enough motion at the fracture site to generate excellent callus. Since TENs were first introduced in North America, our Level 1 Pediatric Trauma Center has prospectively followed all of its TEN patients. In this article, we present lessons from the learning curve of our first 50 cases--focusing on complications and their prevention. In the course of obtaining predominately excellent results, we have learned several important principles regarding TEN preoperative planning, operative technique, and aftercare. The most common problem encountered has been irritation at the nail insertion site (18% of cases). Very proximal fractures may be more challenging; unstable fractures and fractures in larger, older children are best managed with a short period of adjunctive immobilization.
传统上，小儿股骨干骨折的首选治疗方法是牵引和石膏固定。新的方法则侧重于早期活动和缩短住院时间。使用逆行钛弹性髓内钉（TEN）可以加快骨折稳定，同时允许骨折部位有足够的活动以产生良好的骨痂。自从TEN首次在北美引入以来，我们的一级小儿创伤中心对所有接受TEN治疗的患者进行了前瞻性随访。在本文中，我们介绍了前50例病例学习曲线中的经验教训——重点关注并发症及其预防。在取得主要为良好结果的过程中，我们学到了一些关于TEN术前规划、手术技术和术后护理的重要原则。最常见的问题是钉插入部位的刺激（18%的病例）。非常近端的骨折可能更具挑战性；不稳定骨折以及年龄较大、体型较大儿童的骨折，最好辅以短期固定。
