Hanf-Osetek Dorota, Bilski Paweł, Łabądź Dawid, Snela Sławomir
Department of Pediatric Orthopedic, Clinical Regional Hospital No. 2.
Institute of Medicine, College for Medical Sciences of University of Rzeszow, Rzeszow, Poland.
J Pediatr Orthop B. 2023 May 1;32(3):253-259. doi: 10.1097/BPB.0000000000000986. Epub 2022 May 3.
Currently the gold standard in surgical treatment of displaced tibial shaft fractures in children with open growth cartilage is elastic stable intramedullary nailing (ESIN). The purpose of this study is the analysis of indications, complications, and duration of treatment using intramedullary flexible nails in children who are still growing but especially weighing 50 kg or more. Hospital records from 2017 to 2020 were retrospectively reviewed to identify the children from 4 to 17 years of age with displaced tibial shaft fractures admitted to the hospital. Only children with open growth cartilage, with a minimum of 6 months of follow-up and complete clinical data, were included. Studies of 91 children xwere analyzed. The average patient age at the time of the injury was 10.88 ± 2.82 years. In the entire group, 31.9% children weighed 50 kg or more, and 68.1% of the children were below this weight. All children were treated using ESIN. The mean time to nail removal was 8.4 ± 4.09 months in the whole group of children stabilized with ESIN. There were no differences in the two groups depending on the weight ( P = 0.637). Only two adverse events were observed. This study demonstrates that the use of ESIN in displaced tibial shaft fractures in growing children weighing 50 kg or more is acceptable and safe. The discussion to be made is whether it is still an acceptable method of treatment for this type of fracture due to the progressive obesity epidemic in children and adolescents.
目前，对于生长板开放的儿童胫骨干骨折，手术治疗的金标准是弹性稳定髓内钉固定术（ESIN）。本研究的目的是分析在仍在生长但体重尤其达到50公斤或以上的儿童中使用髓内弹性钉的适应症、并发症及治疗持续时间。回顾性分析了2017年至2020年的医院记录，以确定4至17岁因胫骨干骨折入院的儿童。仅纳入生长板开放、随访至少6个月且临床资料完整的儿童。对91例儿童的研究进行了分析。受伤时患者的平均年龄为10.88±2.82岁。在整个组中，31.9%的儿童体重达到50公斤或以上，68.1%的儿童低于此体重。所有儿童均采用ESIN治疗。在整个采用ESIN固定的儿童组中，平均拔钉时间为8.4±4.09个月。两组在体重方面无差异（P = 0.637）。仅观察到两例不良事件。本研究表明，在体重50公斤或以上的生长中儿童的胫骨干骨折中使用ESIN是可接受且安全的。鉴于儿童和青少年中日益严重的肥胖流行问题，对于这种类型的骨折，它是否仍然是一种可接受的治疗方法还有待讨论。
