Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
J Am Acad Orthop Surg. 2012 Sep;20(9):596-603. doi: 10.5435/JAAOS-20-09-596.
Currently, surgical management of pediatric femur fracture consists of intramedullary nailing with flexible nails or rigid trochanteric entry nails. Rigid trochanteric entry nails are the implant of choice for femoral fractures in adolescents, whereas titanium elastic nails are popular for the management of length-stable diaphyseal femoral fractures in school-age children. However, higher complication rates have been reported in children with length-unstable diaphyseal femoral fractures treated with titanium elastic nails. These complications may require unplanned surgery. Fracture shortening or angulation can lead to nail prominence or exposure that may require nail shortening or removal. Recently, submuscular plating has been found to be a successful alternative option for management of length-unstable femoral fractures in school-age children. Submuscular plating can also be used in older and/or heavier children who have a femoral canal that is too small to accommodate a rigid intramedullary nail.
目前，小儿股骨干骨折的手术治疗包括髓内钉固定和弹性钉或刚性转子入口钉。刚性转子入口钉是青少年股骨骨折的首选植入物，而钛弹性钉则广泛用于治疗学龄儿童稳定骨干股骨干骨折。然而，对于用钛弹性钉治疗的不稳定骨干股骨干骨折的儿童，报告的并发症发生率更高。这些并发症可能需要计划外手术。骨折缩短或成角可导致钉突出或暴露，可能需要缩短或取出钉。最近，发现肌肉下钢板固定是治疗学龄儿童不稳定骨干股骨干骨折的一种成功替代选择。对于股骨管太小而无法容纳刚性髓内钉的较大和/或较重的儿童，也可以使用肌肉下钢板。
