Sink Ernest L, Faro Francis, Polousky John, Flynn Katherine, Gralla Jane
Department of Orthopaedic Surgery, The Children's Hospital, The University of Colorado, Denver, Aurora, CO 80045, USA.
J Pediatr Orthop. 2010 Oct-Nov;30(7):633-7. doi: 10.1097/BPO.0b013e3181efb89d.
Elastic intramedullary nails are commonly the preferred treatment option for operative stabilization of pediatric diaphyseal femur fractures. Increased complication rates have been reported in unstable fractures and older patients treated with TENs (titanium elastic nails). The reported complications have led to a change in management at our institution: limiting the use of TENs and using submuscular plating and trochanteric entry nails as alternatives. The purpose of this study is to analyze whether this change in management has improved outcomes defined by a decrease in complications between 2 time periods.
This retrospective study compared 2 cohorts of femur fractures: those treated from January 2001 to January 2003 versus those treated from January 2003 to December 2006. Patient's age, weight, fracture type (stable or unstable), operative fixation technique, and complications were compared. Outcomes were measured by major or minor complications that occurred after operative treatment.
Period I consisted of 46 patients and Period II of 95 patients. There was a significant decrease in TEN use in unstable fractures in Period II versus Period I. Submuscular plating increased from 9% in Period I to 28% in Period II. All complications decreased from 52% in Period I to 23% in Period II. Major complications decreased from 22% to 5%, and minor complications decreased from 30% to 18%. Complications in unstable fractures decreased from 57% to 26% and in stable fractures from 48% to 22%.
Outcomes of pediatric femur fractures are improved with limiting the use of TENs to stable fractures. Complications resulting from unstable femur fracture management have decreased with other methods of stabilization such as submuscular plating or trochanteric entry nails.
弹性髓内钉通常是小儿股骨干骨折手术稳定治疗的首选方案。据报道，采用钛弹性髓内钉（TENs）治疗不稳定骨折及年龄较大的患者时并发症发生率会增加。这些报道的并发症促使我们机构改变了治疗方式：限制TENs的使用，并采用肌肉下钢板固定和转子入路髓内钉作为替代方案。本研究的目的是分析这种治疗方式的改变是否通过两个时间段并发症的减少而改善了治疗效果。
这项回顾性研究比较了两组股骨干骨折患者：2001年1月至2003年1月接受治疗的患者与2003年1月至2006年12月接受治疗的患者。比较了患者的年龄、体重、骨折类型（稳定或不稳定）、手术固定技术及并发症情况。通过手术治疗后发生的严重或轻微并发症来衡量治疗效果。
第一阶段有46例患者，第二阶段有95例患者。与第一阶段相比，第二阶段不稳定骨折中TENs的使用显著减少。肌肉下钢板固定的比例从第一阶段的9%增至第二阶段的28%。所有并发症从第一阶段的52%降至第二阶段的23%。严重并发症从22%降至5%，轻微并发症从30%降至18%。不稳定骨折的并发症从57%降至26%，稳定骨折的并发症从48%降至22%。
将TENs的使用限制于稳定骨折可改善小儿股骨干骨折的治疗效果。采用肌肉下钢板固定或转子入路髓内钉等其他稳定方法，可减少不稳定股骨干骨折治疗引起的并发症。
