Altay Mehmet Akif, Erturk Cemil, Cece Hasan, Isikan Ugur Erdem
Department of Orthopaedics and Traumatology, Harran University Faculty of Medicine, Sanliurfa, Turkey.
Acta Orthop Belg. 2011 Apr;77(2):211-7.
The purpose of this study is to compare retrospectively intraoperative fluoroscopy time and clinical-radiological results in pediatric femoral shaft fractures treated with titanium elastic nailing (TEN), with a mini-open "blind-hand" technique versus closed reduction. The study included 87 children (18 girls and 69 boys) who underwent surgical treatment with TEN for femoral shaft fractures. Patients were divided into two groups. Group 1 included 42 patients (mean age : 83 +/- 2.7 years) treated with a mini-open "blind-ha nd" technique (a 2-3 cm lateral incision at the level of the fracture ; reduction achieved with one or two fingers, without visualization of the fracture). Group 2 consisted of 45 patients (mean age: 8.8 +/- 2.6 years) treated with a closed reduction technique. Duration of surgery and intraoperative fluoroscopy time were recorded in both groups. Clinical and radiologic results were assessed using the TEN scoring system after mean follow-up periods of 213 +/- 5.8 months and 193 +/- 5.6 months in group 1 and group 2, respectively. Mean duration of surgery was 31.7 +/- 7.6 and 52.1 +/- 14.4 minutes, and mean fluoroscopy time 32.9 +/- 22.1 and 75.1 +/- 31.5 seconds in group 1 and group 2, respectively. Both surgical and fluoroscopy time were significantly longer in group 2 (p < 0.001). There was no significant difference between the two groups in terms of clinical and radiological results. All fractures healed with solid union, and there was no complication that was expected to cause permanent disability. Although successful clinical and radiological results were obtained with both techniques, duration of surgery and intraoperative fluoroscopy time were significantly higher in the closed reduction group 2. We suggest the "blind-hand" technique as an alternative to closed reduction to prevent extensive intraoperative radiation exposure and to decrease the length of the surgical procedure.
本研究的目的是回顾性比较采用钛弹性髓内钉（TEN）、迷你开放“盲手”技术与闭合复位治疗小儿股骨干骨折时的术中透视时间及临床-放射学结果。该研究纳入了87例接受TEN治疗股骨干骨折的儿童（18例女孩和69例男孩）。患者被分为两组。第1组包括42例患者（平均年龄：8.3±2.7岁），采用迷你开放“盲手”技术治疗（在骨折水平做一个2-3cm的外侧切口；用一两个手指进行复位，不直视骨折部位）。第2组由45例患者（平均年龄：8.8±2.6岁）组成，采用闭合复位技术治疗。记录两组的手术时间和术中透视时间。分别在第1组和第2组平均随访213±5.8个月和193±5.6个月后，使用TEN评分系统评估临床和放射学结果。第1组和第2组的平均手术时间分别为31.7±7.6分钟和52.1±14.4分钟，平均透视时间分别为32.9±22.1秒和75.1±31.5秒。第2组的手术时间和透视时间均显著更长（p<0.001）。两组在临床和放射学结果方面无显著差异。所有骨折均实现牢固愈合，且无预期会导致永久性残疾的并发症。虽然两种技术均取得了成功的临床和放射学结果，但闭合复位的第2组手术时间和术中透视时间显著更长。我们建议采用“盲手”技术替代闭合复位，以避免术中大量辐射暴露并缩短手术时间。
