Liebs Thoralf Randolph, Meßling Anna, Milosevic Milan, Berger Steffen Michael, Ziebarth Kai
Inselspital, Department of Paediatric Surgery, University of Bern, 3010 Bern, Switzerland.
Children (Basel). 2022 Mar 1;9(3):327. doi: 10.3390/children9030327.
(1) Background: In adolescents, fractures of the femoral shaft that are not suitable for elastic-stable-intramedullary-nailing (ESIN), are challenging. We aimed to evaluate the health-related quality of life (HRQoL) and complications in adolescents treated with intramedullary rodding using the adolescent lateral trochanteric entry femoral nail (ALFN), and to assess if HRQoL was associated with additional injuries. (2) Methods: We followed-up on 15 adolescents with a diaphyseal femoral fracture who were treated with an ALFN from 2004 to 2017. Patients were asked to fill in a questionnaire that includes the iHOT, Peds-QL, and the Pedi-IKDC. (3) Results: The ALFN was used as a primary method of fixation in 13 patients, and as a fixation for failed ESIN in two cases. All 15 fractures healed radiographically. One distal locking screw broke. After a mean follow-up of 2.8 years, the mean iHOT-12 was 14.0 (SD 15.4), PedsQL-function was 85.7 (SD 19.3), PedsQL-social-score was 86.2 (SD 12.5), and the mean Pedi-IKDC was 77.2 (SD 11.3). In patients where the femoral fracture was an isolated injury, the HRQoL-scores were consistently higher compared with patients who sustained additional injures. (4) Conclusions: Treating diaphyseal fractures in adolescents with an ALFN resulted in good radiographic outcomes in all our cases. HRQoL, as measured by the iHOT, PedsQL, and Pedi-IKDC, was good to excellent; but it was consistently inferior in patients with additional injuries. These results suggest that the ALFN is a good alternative when patients are not suitable for ESIN, and that the HRQoL of adolescents who were treated with an ALFN is mainly influenced by the presence of additional injures, and less by the fracture of the femur itself.
(1) 背景：在青少年中，股骨干骨折若不适合采用弹性稳定髓内钉固定术（ESIN），治疗颇具挑战性。我们旨在评估使用青少年外侧大转子入路股骨钉（ALFN）进行髓内棒固定治疗的青少年的健康相关生活质量（HRQoL）及并发症，并评估HRQoL是否与其他损伤相关。(2) 方法：我们对2004年至2017年期间接受ALFN治疗的15例股骨干骨折青少年进行了随访。患者被要求填写一份包含iHOT、儿童生活质量量表（Peds-QL）和儿童国际膝关节文献委员会主观膝关节评估表（Pedi-IKDC）的问卷。(3) 结果：13例患者将ALFN用作主要固定方法，2例患者将其用于ESIN失败后的固定。所有15处骨折均经影像学检查愈合。1枚远端锁定螺钉断裂。平均随访2.8年后，iHOT-12平均分为14.0（标准差15.4），PedsQL功能评分为85.7（标准差19.3），PedsQL社会评分为86.2（标准差12.5），Pedi-IKDC平均分为77.2（标准差11.3）。与遭受其他损伤的患者相比，股骨骨折为孤立损伤的患者的HRQoL评分始终更高。(4) 结论：在我们所有病例中，使用ALFN治疗青少年股骨干骨折均取得了良好的影像学结果。通过iHOT、PedsQL和Pedi-IKDC测量的HRQoL良好至优秀；但在有其他损伤的患者中始终较差。这些结果表明，当患者不适合ESIN时，ALFN是一种很好的替代方法，并且接受ALFN治疗的青少年的HRQoL主要受其他损伤的影响，受股骨骨折本身的影响较小。
