Crosby Samuel N, Kim Elliott J, Koehler Daniel M, Rohmiller Michael T, Mencio Gregory A, Green Neil E, Lovejoy Steven A, Schoenecker Jonathan G, Martus Jeffrey E
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus:
Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242.
J Bone Joint Surg Am. 2014 Jul 2;96(13):1080-1089. doi: 10.2106/JBJS.M.01128.
Debate exists over the safety of rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients. The goal of this study was to describe functional outcomes and complication rates of rigid intramedullary nailing in pediatric patients.
A retrospective review was performed of femoral shaft fractures in skeletally immature patients treated with trochanteric rigid intramedullary nailing from 1987 to 2009. Radiographs made at initial injury, immediately postoperatively, and at the latest follow-up were reviewed. Patients were administered the Nonarthritic Hip Score and a survey.
The study population of 241 patients with 246 fractures was primarily male (75%) with a mean age of 12.9 years (range, eight to seventeen years). The majority of fractures were closed (92%) and associated injuries were common (45%). The mean operative time was 119 minutes, and the mean estimated blood loss was 202 mL. The mean clinical follow-up time was 16.2 months (range, three to seventy-nine months), and there were ninety-three patients with a minimum two-year clinical and radiographic follow-up. An increase of articulotrochanteric distance of >5 mm was noted in 15.1% (fourteen of ninety-three patients) at a minimum two-year follow-up; however, clinically relevant growth disturbance was only observed in two patients (2.2%) with the development of asymptomatic coxa valga. There was no femoral head osteonecrosis. Among the 246 fractures, twenty-four complications (9.8%) occurred. At the time of the latest follow-up, 1.7% (four of 241 patients) reported pain. The average Nonarthritic Hip Score was 92.4 points (range, 51 to 100 points), and 100% of patients reported satisfaction with their treatment.
Rigid intramedullary nailing is an effective technique for treatment of femoral shaft fractures in pediatric patients with an acceptable rate of complications.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
对于骨骼未成熟患者股骨干骨折采用刚性髓内钉固定的安全性存在争议。本研究的目的是描述小儿患者刚性髓内钉固定的功能结果和并发症发生率。
对1987年至2009年采用转子间刚性髓内钉固定治疗的骨骼未成熟患者的股骨干骨折进行回顾性研究。回顾了初始损伤时、术后即刻及最新随访时的X线片。对患者进行非关节炎髋关节评分并开展一项调查。
研究人群包括241例患者共246处骨折，主要为男性（75%），平均年龄12.9岁（范围8至17岁）。大多数骨折为闭合性（92%），合并伤常见（45%）。平均手术时间为119分钟，平均估计失血量为202毫升。平均临床随访时间为16.2个月（范围3至79个月），有93例患者至少有两年的临床和影像学随访。在至少两年的随访中，93例患者中有15.1%（14例）的关节转子间距离增加>5毫米；然而，仅在2例患者（2.2%）中观察到与临床相关的生长紊乱，表现为无症状性髋外翻。未发生股骨头坏死。在246处骨折中，发生了24例并发症（9.8%）。在最新随访时，1.7%（241例患者中的4例）报告有疼痛。非关节炎髋关节评分平均为92.4分（范围51至100分），100%的患者对其治疗表示满意。
刚性髓内钉固定是治疗小儿股骨干骨折的有效技术，并发症发生率可接受。
治疗性四级证据。有关证据水平的完整描述，请参阅作者须知。
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