Wang R F, Lou Y, Tang K, Liu G P, Chen M C, Lin G
Department of Pediatric Orthopaedic, Children's Hospital, Nanjing Medical University, Nanjing 210019, China.
Zhonghua Wai Ke Za Zhi. 2019 Feb 1;57(2):129-133. doi: 10.3760/cma.j.issn.0529-5815.2019.02.011.
To investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture. A retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children's Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11.5±0.8) years (range: 8-14 years).Patients underwent surgery in (12.0±0.9) hours (range: 6-20 hours) after the injury. Displaced fractures were treated by open reduction if closed reduction failed.The surgical incision was performed with the anterior inferior iliac spine centered on, extending along the groin crease, and the length was 3 to 4 cm. The interval between the sartorius and the tensor fascia latae was applied, and the direct and indirect head of rectus femoris were resected to visualize the hip joint capsule. T-shaped incision was made in the capsule. After the reduction was obtained, two or three compression canulated screws were used to fix the fracture site. The healing time, complications and corresponding record outcome by X-ray and clinical examination were recorded. At the latest follow-up,the results were analyzed using the Ratliff criteria and clinical outcomes were assessed by pain, restrictive hip movement, normal activity or the avoidance of games, and the femoral neck in the radiograph. Twelve patients had been followed-up for (30.0±4.1)months(range: 24-36 months). X-ray showed the fractures' healing time was (8.0±0.4) weeks(range: 7-9 weeks). Ten of the 12 fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. One case occurred premature physeal closure. There were no cases with fracture relocation, coaxvara, delayed union and nonunion or any significant postoperative complications. There was no infection, flexible internal fixation or ruptures. According to Ratliff grade, 9 cases of 12 patients were fine and 3 cases was acceptable. Satisfactory short-term effects can be achieved by a mini-incision on the anterior hip for Delbet Ⅱ pediatric femur neck fractures. The anterior incision has the advantage of less trauma, smaller incision scar, better fracture reduction and fixation, and less wound complications.
探讨髋前短切口切开复位内固定治疗儿童DelbetⅡ型股骨颈骨折的早期临床疗效。回顾性分析2014年1月至2016年8月南京医科大学附属儿童医院小儿骨科采用前短切口入路治疗的12例DelbetⅡ型股骨颈骨折患儿的临床资料。其中男7例,女5例;左侧8例,右侧4例;年龄(11.5±0.8)岁(8~14岁)。受伤后(12.0±0.9)小时(6~20小时)行手术治疗。闭合复位失败的移位骨折采用切开复位。手术切口以髂前下棘为中心,沿腹股沟皱襞延长,长3~4 cm。分开缝匠肌与阔筋膜张肌间隙,切除股直肌直头和斜头以显露髋关节囊。在关节囊上做T形切口。复位后,用2~3枚加压空心螺钉固定骨折部位。记录愈合时间、并发症以及X线和临床检查的相应记录结果。末次随访时,采用Ratliff标准进行结果分析,通过疼痛、髋关节活动受限、正常活动或避免运动以及X线片上的股骨颈情况评估临床疗效。12例患儿均获随访,随访时间(30.0±4.1)个月(24~36个月)。X线显示骨折愈合时间为(8.0±0.4)周(7~9周)。12例骨折中10例一次手术愈合,股骨头无坏死迹象。1例发生过早骨骺闭合。无骨折再移位、髋内翻、延迟愈合、不愈合及术后严重并发症发生。无感染、内固定松动或断裂。按Ratliff分级,12例中9例优良,3例可接受。采用髋前小切口治疗儿童DelbetⅡ型股骨颈骨折可获得满意的短期疗效。前切口具有创伤小、切口瘢痕小、骨折复位固定好、伤口并发症少等优点。