Miller M E, Bramlett K W, Kissell E U, Niemann K M
Clin Orthop Relat Res. 1987 Jun(219):140-6.
In the past 15 to 20 years, little improvement has been made in the standard treatment of femur fractures in children. Children younger than two years of age or weighing less than 30 pounds are normally treated with skin traction or immobilized in a plaster cast or both. Older or heavier children are often treated with skeletal traction, followed by early or late application of spica cast in the neutral position. A method of spica cast treatment that immobilizes the limb in the 90-90 position using a reinforced cast incorporating a distal femoral traction pin--the pontoon spica--allows for early cast application and discharge from the hospital and encourages early motion of the knee joint. A series of 23 femur fractures in 21 patients were treated with this method. This series is compared with a series of 38 fractures treated with conventional methods. The follow-up period ranged from three to 24 months. The pontoon method provided better results in control of alignment than the conventional method, with no greater discrepancy in leg lengths than generally observed after skin traction and hip spica casts. The average hospital cost reduction was 73%, or approximately $13,334. There were no major complications with the pontoon method, which is now a standard treatment for femoral fractures in children.
在过去15至20年里，儿童股骨骨折的标准治疗方法几乎没有改进。两岁以下或体重不足30磅的儿童通常采用皮肤牵引治疗，或用石膏固定，或两者并用。年龄较大或体重较重的儿童通常采用骨骼牵引治疗，随后在中立位早期或晚期应用髋人字石膏。一种髋人字石膏治疗方法，即使用带有股骨远端牵引针的加固石膏将肢体固定在90-90位——浮桥髋人字石膏——可允许早期应用石膏并出院，并鼓励膝关节早期活动。对21例患者的23处股骨骨折采用该方法进行治疗。将该系列病例与采用传统方法治疗的38处骨折病例进行比较。随访期为3至24个月。与传统方法相比，浮桥法在控制对线方面效果更好，腿长差异不大于皮肤牵引和髋人字石膏治疗后通常观察到的差异。平均住院费用降低了73%，约为13334美元。浮桥法没有出现重大并发症，目前已成为儿童股骨骨折的标准治疗方法。
