Astur Diego da Costa, Arliani Gustavo Gonçalves, Nascimento Carolina Lins E Silva, Blumetti Francesco Camara, Fonseca Marcio José Alher, Dobashi Eiffel Tsuyoshi, Pinto José Antonio, Ishida Akira
Resident Physician in the Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
Undergraduate Medical Student at the Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
Rev Bras Ortop. 2015 Nov 17;45(4):426-32. doi: 10.1016/S2255-4971(15)30392-X. eCollection 2010 Jul-Aug.
We developed this study with the aim of evaluating the results from treating patients with proximal femoral fractures, in a series of cases. We sought to observe the influence of the most prevalent complications on the final results after a minimum follow-up of two years. We especially considered the relationship between establishment of avascular necrosis and the time between the accident and the therapeutic intervention.
We retrospectively studied proximal extremity fractures of the femur in 29 patients under 14 years of age between 1988 and 2007. We analyzed the following variables: sex, age, mechanism of injury, fracture classification (Delbet), treatment administered, complications (pseudarthrosis, varus deformity, leg length discrepancy and avascular necrosis), duration of surgery and results (Ratliff). We carried out individual descriptive analysis on each variable. The tests were used in accordance with the premise that normality applied. For the evaluation, we used Fisher's exact test.
Five patients (17.2%) had avascular necrosis, and three of them (60.0%) were over 10 years of age. 73.3% of the patients treated within the first 24 hours showed good results. The most common cause of fractures was traffic accidents (44.8%). The best results were observed among patients who were treated surgically. 41.4% developed some type of complication.
Among the 29 patients treated, 58.6% had good, 27.6% had regular and 13.8% had poor results, according to the Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while 69.3% had good results from surgical intervention. Likewise, 73.3% of the results were good results when surgery was performed within the first 24 hours and only 42.8% of the results were good among patients who underwent surgery after this period. Patients operated within the first 24 hours developed necrosis of the femoral head in 13.3% of cases, while 21.4% of those operated after this period developed this complication.
我们开展本研究旨在评估一系列股骨近端骨折患者的治疗结果。我们试图观察在至少两年的随访后，最常见并发症对最终结果的影响。我们特别考虑了股骨头缺血性坏死的发生与事故和治疗干预之间时间的关系。
我们回顾性研究了1988年至2007年间29例14岁以下股骨近端骨折患者。我们分析了以下变量：性别、年龄、损伤机制、骨折分类（德尔贝分类法）、治疗方式、并发症（假关节、内翻畸形、肢体长度差异和股骨头缺血性坏死）、手术时长和结果（拉特利夫标准）。我们对每个变量进行了个体描述性分析。根据正态性假设使用相应检验。评估时，我们使用了费舍尔精确检验。
5例患者（17.2%）发生股骨头缺血性坏死，其中3例（60.0%）年龄超过10岁。在伤后24小时内接受治疗的患者中，73.3%的患者结果良好。骨折最常见的原因是交通事故（44.8%）。接受手术治疗的患者观察到最佳结果。41.4%的患者出现了某种类型的并发症。
根据拉特利夫标准，在接受治疗的29例患者中，58.6%的患者结果良好，27.6%的患者结果一般，13.8%的患者结果较差。采用保守治疗时，只有17.0%的患者结果良好，而手术干预后69.3%的患者结果良好。同样，伤后24小时内进行手术的患者中73.3%的结果良好，而在此时间段后接受手术的患者中只有42.8%的结果良好。伤后24小时内接受手术的患者中13.3%发生股骨头坏死，而在此时间段后接受手术的患者中有21.4%发生此并发症。
