Allen Jerad D, Murr Kevin, Albitar Ferras, Jacobs Cale, Moghadamian Eric S, Muchow Ryan
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, KY.
J Pediatr Orthop. 2018 Mar;38(3):e111-e117. doi: 10.1097/BPO.0000000000001129.
American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for pediatric femoral shaft fractures indicate titanium elastic nails (TENs) for children 5 to 11 years old. Growing evidence suggests these fractures may also be treated with open or submuscular plating. The purpose of this study was to compare estimated blood loss (EBL), operative time, fluoroscopy time, cost, and subjective and objective pain scores between TENs and plating techniques used in 5- to 11-year-old children with midshaft femur fractures based on length stability. We hypothesized that EBL, operative time, and fluoroscopy time would be greater and pain would be lower with plate fixation.
We retrospectively identified all pediatric midshaft femur fractures treated with TENs, submuscular plating, or open plating between 2004 and 2014. Demographic, injury, and surgical data were obtained for analysis. Cost data were obtained from Synthes Inc. Outcomes were determined using the TEN outcome scoring system. Variables were compared between the 3 fixation methods using paired t tests or Fisher exact test as appropriate. Cost data were compared with Mann-Whitney nonparametric test.
There were 65 midshaft femur fractures in 63 patients included. TENs accounted for 77% and plating 23%. There were no statistical differences in injury severity score, length of stay, length unstable fractures, open fractures, fluoroscopy time, or pain. However, there was a significantly greater operative time (P=0.007) and a notably greater EBL (P=0.057) for the plating technique compared with TENs. Patient outcomes were found to be equivalent. Implant cost was not significantly different although increased surgical costs were seen in plating (P=0.0007).
This study supports the use of TENs or plating for midshaft femur fractures in children 5 to 11 years old, regardless of length stability. The use of plates resulted in higher EBL, longer operative time, increased cost, and equivalent pain compared with TENs. To our knowledge, this study represents the first direct comparison of the common fixation methods specifically for midshaft femur fractures and favors the use of TENs.
Level III.
美国矫形外科医师学会（AAOS）关于儿童股骨干骨折的临床实践指南指出，对于5至11岁的儿童可使用钛弹性髓内钉（TEN）。越来越多的证据表明，这些骨折也可用切开复位或肌下钢板固定治疗。本研究的目的是比较基于长度稳定性，在5至11岁股骨干中段骨折儿童中使用TEN和钢板固定技术时的估计失血量（EBL）、手术时间、透视时间、费用以及主观和客观疼痛评分。我们假设钢板固定时EBL、手术时间和透视时间会更长，而疼痛会更低。
我们回顾性分析了2004年至2014年间所有采用TEN、肌下钢板固定或切开复位钢板固定治疗的儿童股骨干中段骨折病例。获取人口统计学、损伤和手术数据进行分析。费用数据来自辛迪思公司（Synthes Inc.）。使用TEN结局评分系统确定结局。根据情况，使用配对t检验或Fisher精确检验对三种固定方法之间的变量进行比较。费用数据采用Mann-Whitney非参数检验进行比较。
纳入63例患者的65个股骨干中段骨折病例。TEN治疗占77%，钢板固定占23%。损伤严重程度评分、住院时间、不稳定骨折长度、开放性骨折、透视时间或疼痛方面无统计学差异。然而，与TEN相比，钢板固定技术的手术时间显著更长（P = 0.007），EBL明显更多（P = 0.057）。发现患者结局相当。植入物费用无显著差异，尽管钢板固定的手术费用有所增加（P = 0.0007）。
本研究支持在5至11岁儿童股骨干中段骨折中使用TEN或钢板固定，无论骨折长度稳定性如何。与TEN相比，使用钢板导致更高的EBL、更长的手术时间、更高的费用以及相当的疼痛程度。据我们所知，本研究是首次对专门用于股骨干中段骨折的常见固定方法进行直接比较，且更倾向于使用TEN。
III级。
