钛弹性髓内钉与钢板固定小儿股骨转子下骨折的比较

Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures.

作者信息

Li Ying, Heyworth Benton E, Glotzbecker Michael, Seeley Mark, Suppan Catherine A, Gagnier Joel, VanderHave Kelly L, Caird Michelle S, Farley Frances A, Hedequist Daniel

机构信息

Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI 48109-4241, USA.

出版信息

J Pediatr Orthop. 2013 Apr-May;33(3):232-8. doi: 10.1097/BPO.0b013e318288b496.

DOI:10.1097/BPO.0b013e318288b496

PMID:23482257

Abstract

BACKGROUND

Studies have demonstrated a higher risk of complications when children with fractures in the proximal third of the femur and length-unstable fractures are treated with titanium elastic nails. Alternative treatment methods include open plating and submuscular plating. We are not aware of any published studies that directly compare titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. The purpose of the present study was to retrospectively compare the outcomes and complications of titanium elastic nail and plate fixation of subtrochanteric femur fractures in children and young adolescents.

METHODS

A total of 54 children aged 5 to 12 years with subtrochanteric femur fractures treated with titanium elastic nails or plating at 2 institutions between 2003 and 2010 were identified. We retrospectively compared 25 children treated with titanium elastic nails to 29 children treated with either open plating or submuscular plating. Similar to previous studies, a fracture that was located within 10% of the total femur length below the lesser trochanter was classified as subtrochanteric. Outcomes were classified as excellent, satisfactory, or poor. A major complication was defined as any complication that led to unplanned surgery. Minor complications were defined as complications that resolved with nonoperative treatment or did not require any treatment.

RESULTS

Outcome scores were significantly better in the plating group (P=0.03), but both groups demonstrated high rates of excellent and satisfactory results. The overall complication rate was significantly higher in the titanium elastic nails group (48%; 12 of 25) when compared with the plating group (14%; 4 of 29) (P=0.008). Patients in the titanium elastic nails group were advanced to full weightbearing significantly earlier (6.6 vs. 9.9 wk) (P=0.005). The major complication rate, length of hospitalization, and time to radiographic union were similar for the 2 groups.

CONCLUSIONS

Our results indicate that plate fixation of pediatric subtrochanteric femur fractures is associated with better outcome scores and a lower overall complication rate when compared with titanium elastic nails.

LEVEL OF EVIDENCE

Therapeutic Level III.

摘要

背景

研究表明，使用钛弹性髓内钉治疗股骨近端三分之一骨折及长度不稳定骨折的儿童时，并发症风险较高。其他治疗方法包括切开复位钢板内固定和肌下钢板内固定。我们尚未发现有任何已发表的研究直接比较钛弹性髓内钉与钢板固定治疗儿童股骨转子下骨折的效果。本研究的目的是回顾性比较钛弹性髓内钉与钢板固定治疗儿童及青少年股骨转子下骨折的疗效和并发症。

方法

确定2003年至2010年期间在2家机构接受钛弹性髓内钉或钢板治疗的54例5至12岁股骨转子下骨折患儿。我们回顾性比较了25例接受钛弹性髓内钉治疗的患儿与29例接受切开复位钢板内固定或肌下钢板内固定治疗的患儿。与既往研究相似，位于小转子下方股骨总长度10%范围内的骨折被归类为转子下骨折。疗效分为优、良、差。主要并发症定义为任何导致计划外手术的并发症。次要并发症定义为通过非手术治疗得以解决或无需任何治疗的并发症。

结果

钢板固定组的疗效评分显著更好（P = 0.03），但两组的优和良的比例均较高。与钢板固定组（14%；29例中有4例）相比，钛弹性髓内钉组的总体并发症发生率显著更高（48%；25例中有12例）（P = 0.008）。钛弹性髓内钉组的患儿更早达到完全负重（6.6周对9.9周）（P = 0.005）。两组的主要并发症发生率、住院时间和影像学愈合时间相似。