Sutphen Sean A, Mendoza Juan D, Mundy Andrew C, Yang Jingzhen G, Beebe Allan C, Samora Walter P, Klingele Kevin E
Orthopedics. 2016 Nov 1;39(6):353-358. doi: 10.3928/01477447-20160719-03. Epub 2016 Jul 27.
This study compared the radiographic and clinical outcomes of pediatric diaphyseal femur fractures treated by submuscular plating, flexible retrograde intramedullary nailing, or rigid antegrade intramedullary nailing with a trochanteric entry point in skeletally immature patients who were 8 years and older. A retrospective review was conducted of skeletally immature patients 8 years and older who were treated for femur fracture with submuscular plating, flexible intramedullary nailing, or rigid intramedullary nailing from 2001 to 2014 with a minimum 12-week follow-up. Treatment outcomes were compared for statistical significance, including time to union, malunion, nonunion, heterotopic ossification, avascular necrosis, time to full weight bearing, limb length discrepancy, residual limp, painful hardware, and infection. The study identified 198 femur fractures in 196 patients (mean age, 11.9 years). Each femur fracture was treated with submuscular plating (35), flexible intramedullary nailing (61), or rigid intramedullary nailing (102). Mean follow-up across the cohort was 48 weeks, ranging from 12 to 225 weeks. Flexible nailing was associated with an increased incidence of malunion (P<.0001) and hardware irritation (P=.0204) and longer time to full weight bearing (P=.0018). Rigid nailing was associated with an increased incidence of limp at 12-week followup (P=.0412). Additionally, 23.5% of patients who were treated with rigid nailing had heterotopic ossification. Of all surgical methods, submuscular plating allowed for the most rapid return to full weight bearing (mean, 7 weeks) and offered the fastest healing rate (mean, 6 weeks). Submuscular plating resulted in faster times to union and full weight bearing, with minimal complication rates. Rigid intramedullary nailing with trochanteric entry resulted in a lower incidence of malunion and hardware-related complications; however, these patients had an increased incidence of heterotopic ossification and residual limp postoperatively. Flexible retrograde intramedullary nailing resulted in the highest rates of malunion and hardware irritation and the longest time to full weight bearing. [Orthopedics. 2016; 39(6):353-358.].
本研究比较了在8岁及以上骨骼未成熟患者中，采用肌下钢板固定、弹性逆行髓内钉固定或经转子入点的刚性顺行髓内钉固定治疗小儿股骨干骨折的影像学和临床结果。对2001年至2014年期间采用肌下钢板固定、弹性髓内钉固定或刚性髓内钉固定治疗股骨骨折且随访至少12周的8岁及以上骨骼未成熟患者进行了回顾性研究。比较治疗结果的统计学意义，包括愈合时间、畸形愈合、不愈合、异位骨化、缺血性坏死、完全负重时间、肢体长度差异、残留跛行、内固定疼痛和感染。该研究确定了196例患者中的198处股骨骨折（平均年龄11.9岁）。每处股骨骨折均采用肌下钢板固定（35例）、弹性髓内钉固定（61例）或刚性髓内钉固定（102例）。整个队列的平均随访时间为48周，范围为12至225周。弹性髓内钉固定与畸形愈合发生率增加（P<0.0001）、内固定刺激（P=0.0204）以及完全负重时间延长（P=0.0018）相关。刚性髓内钉固定与12周随访时跛行发生率增加（P=0.0412）相关。此外，采用刚性髓内钉固定治疗的患者中有23.5%发生了异位骨化。在所有手术方法中，肌下钢板固定允许最快恢复完全负重（平均7周），并提供最快的愈合速度（平均6周）。肌下钢板固定导致愈合和完全负重时间更快，并发症发生率最低。经转子入点的刚性髓内钉固定导致畸形愈合和与内固定相关的并发症发生率较低；然而，这些患者术后异位骨化和残留跛行的发生率增加。弹性逆行髓内钉固定导致畸形愈合和内固定刺激的发生率最高，完全负重时间最长。[《骨科》。2016；39(6):353 - 358。]
