Abbott Matthew D, Loder Randall T, Anglen Jeffrey O
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
J Pediatr Orthop. 2013 Jul-Aug;33(5):519-23. doi: 10.1097/BPO.0b013e318287056d.
Plate osteosynthesis is an accepted method of treatment of pediatric femur fractures. Historically, open plating has been used. Submuscular bridge plating has gained recent popularity due to the theoretical advantages of decreased operative time, decreased blood loss, and decreased risk for infection. The purpose of this study was to compare submuscular bridge plating to open plating of pediatric femur fractures.
We retrospectively reviewed 79 patients (80 treated femur fractures) between 1999 and 2011 that underwent either open plating (58 femur fractures) or submuscular bridge plating (22 femur fractures). The outcome measures evaluated were operative time, estimated blood loss, malunion, leg length discrepancy, time to union, infection, unplanned return to the operating room, and length of hospital stay after surgery.
Among our outcome measures, there was no difference between the 2 groups in terms of operative time, leg length discrepancy, time to union, infection, or length of hospital stay after surgery. There was greater estimated blood loss in the open plating group (P≤0.0001) and greater rotational asymmetry in the submuscular bridge plating group (P=0.005). There was a trend of increased unplanned return to the operating room in the open plating group (5/58 vs. 0/22) although not statistically significant (P=0.32).
Submuscular bridge plating and open plating seem to be equally viable options for the management of pediatric diaphyseal femur fractures. In this study, open plating had an increase in estimated blood loss and a trend of more unplanned returns to the operating room, whereas submuscular bridge plating had an increase in asymptomatic rotational asymmetry. Further larger, prospective, randomized studies are necessary to further evaluate these operative techniques.
Therapeutic Level III.
钢板内固定是治疗小儿股骨骨折的一种公认方法。从历史上看，一直采用切开复位钢板内固定术。近年来，肌下桥接钢板内固定术因具有手术时间缩短、失血减少和感染风险降低等理论优势而受到欢迎。本研究的目的是比较小儿股骨骨折的肌下桥接钢板内固定术与切开复位钢板内固定术。
我们回顾性分析了1999年至2011年间接受切开复位钢板内固定术（58例股骨骨折）或肌下桥接钢板内固定术（22例股骨骨折）的79例患者（80处治疗的股骨骨折）。评估的结果指标包括手术时间、估计失血量、畸形愈合、肢体长度差异、愈合时间、感染、非计划重返手术室情况以及术后住院时间。
在我们的结果指标中，两组在手术时间、肢体长度差异、愈合时间、感染或术后住院时间方面无差异。切开复位钢板内固定组的估计失血量更多（P≤0.0001），肌下桥接钢板内固定组的旋转不对称性更大（P = 0.005）。切开复位钢板内固定组有非计划重返手术室的趋势（5/58 vs. 0/22），尽管无统计学意义（P = 0.32）。
肌下桥接钢板内固定术和切开复位钢板内固定术似乎都是治疗小儿股骨干骨折的同等可行选择。在本研究中，切开复位钢板内固定术的估计失血量增加且有更多非计划重返手术室的趋势，而肌下桥接钢板内固定术有无症状旋转不对称性增加的情况。需要进一步开展更大规模的前瞻性随机研究来进一步评估这些手术技术。
治疗性三级证据。
