Wang WenTao, Mei QianQian, Guo YueMing, He Bo, Mei HaiBo, Li YiQiang, Canavese Federico, Chen ShunYou
Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University.
Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen.
J Pediatr Orthop. 2024 Jan 1;44(1):e7-e14. doi: 10.1097/BPO.0000000000002523. Epub 2023 Sep 22.
The incidence of aggravation or occurrence of avascular necrosis (AVN) following hardware removal in surgically treated pediatric femoral neck fractures who achieved radiologic consolidation is unknown. This study aimed to investigate the risk factors for this complication.
Seventy-one pediatric (mean age: 9.8±3.9 y) were retrospectively analyzed. Risk factors (age, sex, laterality, severity of initial displacement, type of fracture, time from trauma to reduction, reduction and fixation method, quality of reduction, time required to achieve radiologic union, duration of hardware retention, presence of AVN before hardware removal and follow-up time) were recorded. The severity of AVN was assessed based on radiographs with Ratliff's classification.
Following hardware removal, the aggravation/occurrence of AVN was detected in 11 hips (15.5%). Among the 5 hips (7%) with aggravation of AVN, 1 (1.4%) with type II AVN and 3 (4.2%) with type III AVN exhibited aggravation of type I AVN, while the remaining hip (1.4%; type I) showed enlargement of the involved AVN area. Six hips (8.5%) developed AVN following hardware removal: 2 (2.8%) were classified as type I and 4 (5.6%) as type III. Receiver operating characteristic curve analysis indicated that hardware retention >7 months after union is associated with a decreased rate of aggravation or occurrence of AVN of the femoral neck or head following hardware removal.
The incidence of aggravation or occurrence of AVN following hardware removal in surgically treated pediatric femoral neck fractures is 15.5%; hardware retention >7 months after radiologic union may reduce the risk of aggravation or occurrence of AVN of the femoral neck or head postimplant removal.
Level III.
在接受手术治疗且已实现放射学骨愈合的小儿股骨颈骨折患者中，取出内固定装置后发生股骨头缺血性坏死（AVN）加重或出现AVN的发生率尚不清楚。本研究旨在调查这一并发症的危险因素。
对71例小儿患者（平均年龄：9.8±3.9岁）进行回顾性分析。记录危险因素（年龄、性别、侧别、初始移位严重程度、骨折类型、受伤至复位时间、复位及固定方法、复位质量、实现放射学骨愈合所需时间、内固定装置留存时间、取出内固定装置前是否存在AVN以及随访时间）。根据Ratliff分类法通过X线片评估AVN的严重程度。
取出内固定装置后，在11髋（15.5%）中检测到AVN加重/出现。在5髋（7%）AVN加重的病例中，1髋（1.4%）II型AVN加重为I型AVN，3髋（4.2%）III型AVN加重为I型AVN，而其余1髋（1.4%；I型）显示受累AVN区域增大。6髋（8.5%）在取出内固定装置后发生AVN：2髋（2.8%）为I型，4髋（5.6%）为III型。受试者工作特征曲线分析表明，骨折愈合后内固定装置留存时间>7个月与取出内固定装置后股骨颈或股骨头AVN加重或出现的发生率降低相关。
手术治疗的小儿股骨颈骨折取出内固定装置后AVN加重或出现的发生率为15.5%；放射学骨愈合后内固定装置留存时间>7个月可能降低取出内固定装置后股骨颈或股骨头AVN加重或出现的风险。
III级。
