Goodwin Ryan C, Gaynor Tracey, Mahar Andrew, Oka Richard, Lalonde François D
Department of Orthopedics, The Cleveland Clinic Foundation, Cleveland, OH, USA.
J Pediatr Orthop. 2005 Sep-Oct;25(5):570-6. doi: 10.1097/01.mph.0000165135.38120.ce.
Flexible intramedullary nail fixation provides excellent fixation in children with unstable tibial shaft fractures, but few published series demonstrate the results and complications with this technique in children. A retrospective review of 19 patients was performed, as well as a biomechanical analysis of two implant configurations. Outcome measures included union rates, residual deformity, and complications. Union occurred in all cases. Five patients (26%) had complications. None required repeat operation. Two (11%) angular deformities (>/=10 degrees) occurred with the medial C and S construct, versus none with the double C. The C and S construct was more stable to mechanical testing with axial and torsional loading. Flexible intramedullary nail fixation is a straightforward technique that reliably produces good results. While the C and S construct was superior in biomechanical testing, the double C construct is more reliable and straightforward and remains by far the authors' preferred technique.
弹性髓内钉固定术在治疗儿童不稳定胫骨干骨折方面提供了出色的固定效果，但鲜有已发表的系列研究展示该技术在儿童中的治疗结果及并发症情况。我们对19例患者进行了回顾性研究，并对两种植入物构型进行了生物力学分析。观察指标包括骨折愈合率、残留畸形及并发症。所有病例均实现骨折愈合。5例患者（26%）出现并发症，均无需再次手术。内侧C型和S型构型出现2例（11%）成角畸形（≥10度），而双C型构型未出现成角畸形。在轴向和扭转负荷的力学测试中，C型和S型构型更为稳定。弹性髓内钉固定术是一种操作简单的技术，能可靠地产生良好效果。虽然C型和S型构型在生物力学测试中表现更优，但双C型构型更可靠、操作更简单，仍是作者目前首选的技术。
