Coury John G, Lum Zachary C, O'Neill Nicholas P, Gerardi Joseph A
Valley Consortium for Medical Education, 1400 Florida Ave Suite 200, Modesto, CA 95350, USA.
Valley Children's Hospital, 9300 Valley Children's Pl., Madera, CA 93636, USA.
J Orthop. 2017 Jun 24;14(3):394-397. doi: 10.1016/j.jor.2017.06.006. eCollection 2017 Sep.
There has been a trend towards flexible intramedullary nailing for unstable tibial shaft fractures in the pediatric population, traditionally, utilizing a 2-incision technique with passage of one nail medially and one nail laterally. Our study aims to compare a single incision approach for flexible nailing of unstable tibial shaft fractures in pediatric patients to the traditional 2-incision approach.
Patients were selected for operative fixation if they had a length unstable tibial shaft fracture confirmed by fluoroscopy. Exclusion criteria included length stable tibial fractures that could undergo nonoperative treatment. Single incision technique utilized the medial incision only. Patients were monitored in the hospital for one postoperative day and followed up at 4 week, 8 week, and 12 week marks. Radiographic analysis was performed to evaluate for malunion or nonunion. Operative times, infection rates and complications were recorded and analyzed.
All patients achieved complete fracture healing at the 12-week follow up. There were no delayed unions, nonunions or malunions in either treatment group.
Single medial incision for tibial flexible nails had equivalent outcomes with no difference in primary healing rate, malunion or nonunion rate when compared to the dual incision technique.
在儿科人群中，对于不稳定胫骨干骨折，有一种采用弹性髓内钉固定的趋势，传统上采用双切口技术，一枚钉子从内侧穿入，一枚钉子从外侧穿入。我们的研究旨在比较儿科患者不稳定胫骨干骨折弹性髓内钉固定的单切口入路与传统双切口入路。
如果患者经透视证实存在长度不稳定的胫骨干骨折，则选择手术固定。排除标准包括可进行非手术治疗的长度稳定的胫骨骨折。单切口技术仅采用内侧切口。患者术后在医院监测一天，并在术后4周、8周和12周进行随访。进行影像学分析以评估骨不连或骨畸形愈合情况。记录并分析手术时间、感染率和并发症。
所有患者在12周随访时均实现骨折完全愈合。两个治疗组均未出现延迟愈合、骨不连或骨畸形愈合。
与双切口技术相比，胫骨弹性髓内钉单内侧切口的疗效相当，一期愈合率、骨畸形愈合或骨不连率无差异。
