Maier Marcus, Marzi Ingo
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Oper Orthop Traumatol. 2008 Oct-Nov;20(4-5):364-72. doi: 10.1007/s00064-008-1408-6.
Elastic stable intramedullary nailing (ESIN) is a minimally invasive osteosynthesis technique that allows sufficient stabilization of fractures in children.
The stabilization of femur fractures with ESIN is recommended for diapyseal femur fractures in children > or = 4 years until closure of the growth plates.
Open fractures with significant injuries to the soft tissues as well as burst fractures should not be treated with ESIN.
Small incisions are made medial and lateral of the femur just above the distal growth plate. The cortex is perforated with an awl. The first ESIN is pushed via this perforation intramedullary retrograde via the fracture site to the proximal femur near the trochanteric region. Afterwards, the second nail is passed through the opposite cortex of the distal femur after opening it in the same way. The second nail has to be pushed parallel retrograde via the fracture site into the contralateral trochanteric region. The flexible nail design enables the surgeon to fix the fracture via a three-point stabilization.
Postoperative mobilization is allowed on crutches with reduced weight depending on the type of fracture. According to the ESIN position transverse fractures allow an early switch toward full weight bearing, whereas in fractures with multiple fragments, weight bearing should be reduced for several weeks until radiologic healing is seen.
The minimally invasive method of ESIN is a well-accepted treatment option for femur fracture in children yielding good and excellent clinical results. It is the treatment of first choice for transverse and oblique femoral fractures (32-D/4.1 und 32-D/5.1). Fractures with several fragments (32-D/5.2) as well as fractures of the metaphyseal region (31-M/3.1 und 33-M/3.1) may be difficult to stabilize with ESIN and might alternatively be treated with an external fixator.
弹性稳定髓内钉固定术（ESIN）是一种微创接骨术，可对儿童骨折进行充分固定。
对于4岁及以上儿童的股骨干骨折，直至生长板闭合，推荐使用ESIN固定股骨骨折。
伴有严重软组织损伤的开放性骨折以及爆裂骨折不应采用ESIN治疗。
在股骨远端生长板上方的内侧和外侧做小切口。用锥子穿透皮质。第一根ESIN经此穿孔逆行通过骨折部位推送至股骨近端靠近转子区。之后，以同样方式打开股骨远端对侧皮质后，将第二根钉子穿过。第二根钉子必须逆行平行通过骨折部位推送至对侧转子区。弹性钉设计使外科医生能够通过三点固定来固定骨折。
根据骨折类型，允许术后借助拐杖进行减重活动。根据ESIN的位置，横行骨折可早期转向完全负重，而对于多段骨折，负重应减轻数周，直至影像学显示愈合。
ESIN这种微创方法是儿童股骨骨折广泛接受的治疗选择，临床效果良好。它是横行和斜行股骨骨折（32-D/4.1和32-D/5.1）的首选治疗方法。多段骨折（32-D/5.2）以及干骺端区域骨折（31-M/3.1和33-M/3.1）用ESIN可能难以固定，可改用外固定架治疗。
