Karaman Ibrahim, Halici Mehmet, Kafadar Ibrahim H, Guney Ahmet, Oner Mithat, Gurbuz Kağan, Karaman Zehra F
aDepartment of Orthopaedics and Traumatology, Erciyes University Medical Faculty bDepartment of Radiology, Private Modern World Hospital, Kayseri, Turkey.
J Pediatr Orthop B. 2014 May;23(3):212-20. doi: 10.1097/01.bpb.0000444460.95927.05.
The aim of this study was to evaluate the mid-term results of a large series of paediatric patients with long bone shaft fractures who were treated with elastic intramedullary nailing. Between November 2009 and November 2010, 108 long bone shaft fractures in 102 patients were treated with elastic intramedullary nails. The number of nails used, admission time, nail diameter/medullary canal diameter ratio of the nontraumatized extremity, weeks until radiological consolidation, weeks until full weight bearing for the femur and tibia shaft fractures, weeks until the nails were removed, number of radiographs from the diagnosis time to the removal time of nail(s), clinical complications and radiological results were recorded; the union rate, time to union, nonunion, delayed union, malrotation, malalignment, follow-up time and functional outcomes (Flynn outcome scoring) were also recorded. The mean follow-up time was 22.2 (14-30) months. The mean age of the patients was 9.6 (6-15) years for all cases. The mean nail removal time for all cases was 19.2 (17-29) weeks. Eighteen patients developed complications: six had insufficient reductions; two had refractures; four developed a deep infection; one had delayed union that needed revision; two had lower extremity length discrepancies of more than 15 mm; and three had skin impingements. The mean admission time was 19 (6-32) h; the mean number of radiographs from the diagnosis time to the removal time of nail(s) was 14 (8-20) for each fracture. All patients showed excellent or satisfactory results according to Flynn's criteria. The mean time to full weight bearing for the femur and tibia shaft fractures was 62.4 (52-88) days. A nail diameter/medullary canal diameter ratio of over 0.4 showed good results; short union time, less lower extremity length discrepancy and less malalignment were recorded. When patients were informed about possible complications as well as the advantages, almost all chose the operative approach. According to our experience and opinion, elastic intramedullary nailing is the best choice for diaphyseal fractures in children with skeletal immaturity compared with other surgical choices such as osteosynthesis with a plate.
本研究的目的是评估一大系列采用弹性髓内钉治疗的小儿长骨干骨折患者的中期结果。2009年11月至2010年11月期间，102例患者的108处长骨干骨折采用弹性髓内钉治疗。记录使用的钉子数量、入院时间、未受伤肢体的钉直径/髓腔直径比、直至放射学骨愈合的周数、股骨和胫骨干骨折直至完全负重的周数、直至取出钉子的周数、从诊断时间到钉子取出时间的X线片数量、临床并发症和放射学结果；还记录了骨愈合率、愈合时间、骨不连、延迟愈合、旋转畸形、对线不良、随访时间和功能结果（弗林结果评分）。平均随访时间为22.2（14 - 30）个月。所有病例患者的平均年龄为9.6（6 - 15）岁。所有病例的平均取钉时间为19.2（17 - 29）周。18例患者出现并发症：6例复位不充分；2例再次骨折；4例发生深部感染；1例延迟愈合需要翻修；2例下肢长度差异超过15 mm；3例出现皮肤受压。平均入院时间为19（6 - 32）小时；每处骨折从诊断时间到钉子取出时间的X线片平均数量为14（8 - 20）张。根据弗林标准，所有患者均显示出优良或满意的结果。股骨和胫骨干骨折直至完全负重的平均时间为62.4（52 - 88）天。钉直径/髓腔直径比超过0.4显示出良好的结果；记录到愈合时间短、下肢长度差异小和对线不良少。当向患者告知可能的并发症以及优点时，几乎所有患者都选择了手术方法。根据我们的经验和观点，与其他手术选择如钢板接骨术相比，弹性髓内钉是骨骼未成熟儿童骨干骨折的最佳选择。
