儿童股骨干骨折后的下肢长度差异及相关危险因素：一项多中心研究。
Leg-length discrepancy and associated risk factors after paediatric femur shaft fracture: a multicentre study.
作者信息
Kim Tae Gyun, Park Moon Seok, Lee Sang Hyeong, Choi Kug Jin, Im Byeong-Eun, Kim Dae Yeung, Sung Ki Hyuk
机构信息
Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea.
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea.
出版信息
J Child Orthop. 2021 Jun 1;15(3):215-222. doi: 10.1302/1863-2548.15.200252.
PURPOSE
This study was performed to investigate leg-length discrepancy (LLD) and associated risk factors after paediatric femur shaft fractures.
METHODS
A total of 72 consecutive patients under 13 years old (mean age 6.7 years; 48 boys, 24 girls) with unilateral femur shaft fracture, and a minimum follow-up of 18 months, were included. The amount of LLD was calculated by subtracting the length of the uninjured from that of the injured limb. Risk factors for an LLD ≥ 1 cm and ≥ 2 cm were analyzed using multivariable logistic regression analysis.
RESULTS
Hip spica casting, titanium elastic nailing and plating were performed on 22, 40 and ten patients, respectively. The mean LLD was 7.8 mm (sd 8.8) and 29 (40.3%) had a LLD of ≥ 1 cm, while nine (12.5%) had a LLD of ≥ 2 cm. There were significant differences in fracture stability (p = 0.005) and treatment methods (p = 0.011) between patients with LLD < 1 cm and ≥ 1 cm. There were significant differences in fracture site shortening (p < 0.001) and LLD (p < 0.001) between patients with length-stable and length-unstable fractures. Fracture stability was the only factor associated with LLD ≥ 1 cm (odds ratio of 4.0; p = 0.020) in the multivariable analysis.
CONCLUSION
This study demonstrated that fracture stability was significantly associated with LLD after paediatric femur shaft fractures. Therefore, the surgeon should consider the possibility of LLD after length-stable femur shaft fracture in children.
LEVEL OF EVIDENCE
Prognostic level III.
目的
本研究旨在调查小儿股骨干骨折后的下肢长度差异（LLD）及相关危险因素。
方法
纳入72例13岁以下（平均年龄6.7岁；48例男孩，24例女孩）单侧股骨干骨折患者，且至少随访18个月。通过用健侧肢体长度减去伤侧肢体长度来计算LLD量。采用多变量逻辑回归分析LLD≥1 cm和≥2 cm的危险因素。
结果
分别对22例、40例和10例患者进行了髋人字石膏固定、钛弹性髓内钉固定和钢板固定。平均LLD为7.8 mm（标准差8.8），29例（40.3%）LLD≥1 cm，而9例（12.5%）LLD≥2 cm。LLD<1 cm和≥1 cm的患者在骨折稳定性（p = 0.005）和治疗方法（p = 0.011）上存在显著差异。长度稳定型骨折和长度不稳定型骨折的患者在骨折部位缩短（p < 0.001）和LLD（p < 0.001）上存在显著差异。在多变量分析中，骨折稳定性是与LLD≥1 cm相关的唯一因素（比值比为4.0；p = 0.020）。
结论
本研究表明小儿股骨干骨折后的LLD与骨折稳定性显著相关。因此，外科医生应考虑儿童股骨干长度稳定型骨折后出现LLD的可能性。
证据水平
预后III级。
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