Akşahin Ertuğrul, Celebi Levent, Yüksel Halil Yalçin, Hapa Onur, Muratli Hasan Hilmi, Aktekin Cem Nuri, Biçimoğlu Ali
Ankara Numune Education and Research Hospital, Ankara, Turkey.
J Pediatr Orthop. 2009 Jan-Feb;29(1):39-43. doi: 10.1097/BPO.0b013e3181924349.
Immediate hip spica casting is the most commonly used method for the treatment of pediatric femoral fractures. The main disadvantage of the method is the unacceptable shortening (>25 mm), which may occur during the treatment. Buehler et al described the so-called telescope test to identify the cases with a relatively high risk of unacceptable shortening. On the basis of this test, patients with an overriding of the fracture ends of more than 30 mm have a 20.4 times higher risk of unacceptable shortening compared with those with an overriding of less than 30 mm. This relatively higher risk of unacceptable shortening may be avoided by a hip spica cast, which is incorporated to a distal femoral traction pin.
The study consists of 47 (26 boys and 21 girls) patients. Mean age was 40.3 months (range, 18 months to 6 years). Patients were divided into 2 groups according to the telescope test. Group 1 included patients with telescope test results of more than 30 mm. Group 2 included patients with telescope test results of 30 mm or less. All patients were treated with a hip spica cast, which is incorporated to a distal femoral traction pin within 8 hours of the initial trauma. During cast treatment, patients were followed up by weekly x-ray controls for the first month. Patients were assessed for unacceptable shortening and misalignment.
Mean (SD) shortening during cast treatment was 2.9 (5.1) mm on the treated site. Shortening was detected in 16 patients (88.9%) in group 1 and in 7 patients (24.1%) in group 2. A significantly higher number (P < 0.001) of patients developed shortening in group 1. However, unacceptable shortening (>25 mm) did not develop in any patient in both groups. There was no significant frontal plane malalignment in both groups (P > 0.05). Sagittal plane malalignment was significantly higher in group 1 (P < 0.05).
Hip spica cast, which is incorporated to a distal femoral traction pin, avoids unacceptable shortening and frontal plane malalignment in pediatric femoral fractures, which even have a relatively high risk of unacceptable shortening based on the so-called telescope test. However, the technique cannot avoid sagittal malalignment.
即刻髋人字石膏固定是治疗小儿股骨干骨折最常用的方法。该方法的主要缺点是在治疗过程中可能出现难以接受的短缩（>25 mm）。比勒等人描述了所谓的望远镜试验，以识别短缩难以接受风险相对较高的病例。根据该试验，骨折端重叠超过30 mm的患者，其短缩难以接受的风险是重叠小于30 mm患者的20.4倍。通过将髋人字石膏与股骨远端牵引针相结合，可避免这种短缩难以接受的较高风险。
本研究纳入47例患者（26例男孩和21例女孩）。平均年龄为40.3个月（范围18个月至6岁）。根据望远镜试验将患者分为两组。第1组包括望远镜试验结果超过30 mm的患者。第2组包括望远镜试验结果为30 mm或更小的患者。所有患者均接受髋人字石膏固定，并在初次受伤后8小时内与股骨远端牵引针相结合。在石膏治疗期间，第1个月每周进行X线检查以随访患者。评估患者是否存在难以接受的短缩和对线不良情况。
石膏治疗期间，治疗部位的平均（标准差）短缩为2.9（5.1）mm。第1组有16例患者（88.9%）出现短缩，第2组有7例患者（24.1%）出现短缩。第1组出现短缩的患者数量显著更多（P < 0.001）。然而，两组均无患者出现难以接受的短缩（>25 mm）。两组在额状面均无明显对线不良（P > 0.05）。第1组矢状面对线不良明显更高（P < 0.05）。
与股骨远端牵引针相结合的髋人字石膏固定可避免小儿股骨干骨折出现难以接受的短缩和额状面对线不良，即使基于所谓的望远镜试验这些骨折短缩难以接受的风险相对较高。然而，该技术无法避免矢状面对线不良。
