Wang WenTao, Xiong Zhu, Li YiQiang, Guo YueMing, Li Ming, Mei HaiBo, Canavese Federico, Chen ShunYou
Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Department of Pediatric Orthopedics, ShenZhen Children's Hospital, Shenzhen, China.
Orthop Traumatol Surg Res. 2022 Feb;108(1):103052. doi: 10.1016/j.otsr.2021.103052. Epub 2021 Sep 13.
This study aimed: (1) to determine the probability of and the amount of time needed to achieve fracture healing in children with displaced femoral neck fractures (FNFs) treated surgically; and (2) to determine which factors can affect both the probability of and the amount of time needed to achieve radiological fracture healing in those patients.
Pediatric FNFs require longer time to achieve union than previously reported.
We retrospectively reviewed the data of 177 children (mean age 10.5±3.9 years) with FNFs treated surgically. Risk factors, including age, sex, laterality, the mechanism of injury, the initial displacement severity, the type of fracture, the time to reduction, the reduction method, the fixation method and the reduction quality, were recorded. Furthermore, the presence of a comminuted medial or posterior cortex on anteroposterior (AP) or lateral radiographs was also recorded.
A total of 172 hips (97.2%) achieved radiological fracture healing during the follow-up period. Severe initial displacement, a comminuted cortex on the AP or lateral radiographs and poor reduction quality significantly increased the time needed to achieve radiological fracture healing (p<0.05). Cox regression analysis indicated that the cumulative probability of achieving fracture healing increased linearly during the first 6 months and then plateaued, with a monthly increase of less than 5%. The severity of initial displacement, presence/absence of comminution on the medial or posterior cortex, and reduction quality were factors influencing the probability of achieving fracture healing within the first 6 months after injury (p<0.05).
Radiological union of displaced pediatric FNFs treated surgically increases linearly during the first six month after surgery and then it tends to plateau. Risk factors for nonunion are severe initial displacement, poor reduction quality and the presence of comminuted medial or posterior cortex on AP or lateral radiographs; the same factors are associated with a longer time to achieve fracture healing.
III.
本研究旨在：（1）确定手术治疗的儿童移位型股骨颈骨折（FNF）实现骨折愈合的概率及所需时间；（2）确定哪些因素会影响这些患者实现放射学骨折愈合的概率及所需时间。
儿童FNF实现骨愈合所需时间比先前报道的更长。
我们回顾性分析了177例接受手术治疗的FNF儿童（平均年龄10.5±3.9岁）的数据。记录了危险因素，包括年龄、性别、侧别、损伤机制、初始移位严重程度、骨折类型、复位时间、复位方法、固定方法及复位质量。此外，还记录了前后位（AP）或侧位X线片上是否存在粉碎性内侧或后侧皮质。
在随访期间，共有172髋（97.2%）实现了放射学骨折愈合。初始移位严重、AP或侧位X线片上存在粉碎性皮质以及复位质量差显著增加了实现放射学骨折愈合所需的时间（p<0.05）。Cox回归分析表明，骨折愈合的累积概率在最初6个月内呈线性增加，然后趋于平稳，每月增加不到5%。初始移位的严重程度、内侧或后侧皮质是否存在粉碎、复位质量是影响伤后前6个月内实现骨折愈合概率的因素（p<0.05）。
手术治疗的移位型儿童FNF在术后前6个月内放射学骨愈合呈线性增加，然后趋于平稳。骨不连的危险因素包括初始移位严重、复位质量差以及AP或侧位X线片上存在粉碎性内侧或后侧皮质；相同因素与实现骨折愈合所需时间较长有关。
III级。
