Luo Leiming, Lu Xiaobo, Wu Wei, Wang Yuanhui, Ge Jianhua
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Nov;29(11):1337-41.
To compare the effectiveness between open reduction and closed reduction of pediatric subtrochanteric fractures using elastic stable intramedullary nailing (ESIN).
Between January 2010 and January 2014, 22 children with subtrochanteric fractures were treated by ESIN internal fixation combined with hip cast fixation, and the clinical data were retrospectively reviewed. Closed reduction was used in 12 cases (group A) and mini-open reduction in 10 cases (group B). There was no significant difference in gender, age, sides, fracture causes, type of fracture, complications, and time from injury to operation between 2 groups (P > 0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, the limb function was evaluated according to the Flynn et al. outcome score.
The intraoperative blood loss of group A was significantly less than that of group B, but the operation time of group A was significantly longer than that of group B (P < 0.05). All the patients were followed up 12-36 months (mean, 14.9 months). There was no major complications in the other patients of both groups except 1 patient having delayed wound healing in group B. There was no significant difference in fracture healing time between 2 groups (t = -1.006, P = 0.327). Inverted angle of 10° and shortened limb of 1.8 cm were observed in 1 case of group A, and sagittal plane angle of 15° and shortened limb of 2 cm in 1 case of group B. There was no abnormal walking and function of hip and knee activity at last follow-up. According to the Flynn et al. outcome score, the results were excellent in 8 cases and good in 4 cases in group A, and were excellent in 6 cases and good in 4 cases in group B, showing no significant difference between 2 groups (χ2 = 0.041, P = 0.956).
Both closed and open fracture reduction using ESIN have satisfactory outcomes for treating pediatric subtrochanteric fractures. A mini-open reduction should be selected intraoperatively if closed reduction proves to be difficult.
比较弹性髓内钉（ESIN）治疗小儿股骨转子下骨折时切开复位与闭合复位的疗效。
回顾性分析2010年1月至2014年1月采用ESIN内固定联合髋人字石膏固定治疗的22例小儿股骨转子下骨折患者的临床资料。其中12例行闭合复位（A组），10例行小切口切开复位（B组）。两组患者在性别、年龄、骨折侧别、致伤原因、骨折类型、并发症及受伤至手术时间等方面比较，差异均无统计学意义（P>0.05）。记录并比较两组患者的手术时间、术中出血量、骨折愈合时间及并发症情况，根据Flynn等的疗效评分标准评估肢体功能。
A组术中出血量明显少于B组，但手术时间明显长于B组（P<0.05）。所有患者均获随访，随访时间12～36个月，平均14.9个月。除B组1例患者伤口愈合延迟外，两组其余患者均未出现严重并发症。两组骨折愈合时间比较，差异无统计学意义（t=-1.006，P=0.327）。A组1例出现内翻角度10°、肢体短缩1.8 cm，B组1例出现矢状面角度15°、肢体短缩2 cm。末次随访时两组患者均无异常步态，髋、膝关节活动功能正常。根据Flynn等的疗效评分标准，A组优8例，良4例；B组优6例，良4例。两组比较，差异无统计学意义（χ2=0.041，P=0.956）。
ESIN治疗小儿股骨转子下骨折，闭合复位与切开复位均有满意疗效。若闭合复位困难，术中可选择小切口切开复位。
