Kaiser Scott P, Holland Tai, Baidoo Paa Kwesi, Coughlin Richard C, Konadu Peter, Awariyah Dominic, Kumah-Ametepey Raphael A
Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA,
World J Surg. 2014 Nov;38(11):2818-24. doi: 10.1007/s00268-014-2664-2.
In high- and middle-income countries, elastic stable intramedullary nailing (ESIN) is the commonest treatment of femur fractures in children 5-11 years of age. At Komfo Anokye Teaching hospital (KATH) in Kumasi, Ghana, prior to this study all pediatric femur fractures were treated with skin traction to union. This study was designed to report the early results and costs of the adoption of ESIN at KATH to provide data to other low- and middle-income sites considering adoption of this surgical technique.
An observational cohort study that included 84 pediatric patients ages 3-14 years presenting with closed femur fractures and treated with either skin traction or ESIN. Multivariate logistic regression was used to compare the rate of treatment success between treatment groups.
Treatment success (coronal and sagittal angulation less than 10 ° and shortening less than 15 mm at osseous union) was achieved in 92 % of the ESIN group versus 67 % of the skin traction group (odds ratio for ESIN group 9.28 (1.6-54.7); p = 0.0138). Average length of stay was significantly lower in the ESIN group (p = 0.001), but charges to patients were higher in the ESIN group (p < 0.001) because of the high cost of implants.
The initial experience of operative treatment of femoral shaft fractures in children using ESIN was positive, with improved rates of treatment success and no surgical complications. Because of the high cost of implants, direct costs of treatment remained higher with ESIN despite reductions in length of hospital stay.
在高收入和中等收入国家，弹性稳定髓内钉固定术（ESIN）是5至11岁儿童股骨骨折最常用的治疗方法。在加纳库马西的科姆福·阿诺克耶教学医院（KATH），在本研究之前，所有小儿股骨骨折均采用皮肤牵引直至愈合。本研究旨在报告KATH采用ESIN的早期结果和成本，为其他考虑采用这种手术技术的低收入和中等收入地区提供数据。
一项观察性队列研究，纳入84例年龄在3至14岁、患有闭合性股骨骨折且接受皮肤牵引或ESIN治疗的儿科患者。采用多变量逻辑回归比较治疗组之间的治疗成功率。
ESIN组的治疗成功率（冠状面和矢状面成角小于10°，骨愈合时缩短小于15mm）为92%，而皮肤牵引组为67%（ESIN组的优势比为9.28（1.6 - 54.7）；p = 0.0138）。ESIN组的平均住院时间显著缩短（p = 0.001），但由于植入物成本高昂，ESIN组向患者收取的费用更高（p < 0.001）。
使用ESIN治疗儿童股骨干骨折的初步经验是积极的，治疗成功率提高且无手术并发症。由于植入物成本高昂，尽管住院时间缩短，但ESIN的直接治疗成本仍然较高。
