Carey T P, Galpin R D
Department of Surgery (Orthopaedics), University of Western Ontario, London, Canada.
Clin Orthop Relat Res. 1996 Nov(332):110-8. doi: 10.1097/00003086-199611000-00015.
The management of pediatric femoral shaft fractures gradually has evolved toward a more operative approach in the past decade. This is because of a desire for more rapid recovery and reintegration of the patients, and a recognition that prolonged immobilization can have negative effects even in children. Economic pressures also favor a treatment that does not require as prolonged a hospitalization as that required with the traditional traction method. External fixation, compression plating, and intramedullary nailing all have been advocated. A retrospective review of the experience with antegrade flexible intramedullary nailing in 25 children was performed. No nonunions or significant malunions were seen. Followup evaluation of limb lengths and proximal femoral morphology showed minor variations of articulotrochanteric distance and neck shaft angle, none of which were clinically significant. Likewise, minor limb length discrepancies were measured (range, -11- +14 mm) with no consistent pattern of overgrowth noted. There was no evidence of a complete trochanteric growth arrest on radiographic followup. Flexible intramedullary nailing seems to be a safe and effective method for the treatment of femoral shaft fractures in the child between 6 and 12 years of age.
在过去十年中，小儿股骨干骨折的治疗方法已逐渐朝着更积极的手术治疗方向发展。这是因为人们希望患者能更快康复并重新融入正常生活，同时也认识到即使对儿童而言，长期固定也可能产生负面影响。经济压力也促使人们倾向于选择一种住院时间不像传统牵引方法那么长的治疗方式。外固定、加压钢板固定和髓内钉固定等方法都有人提倡。我们对25例儿童顺行弹性髓内钉治疗经验进行了回顾性研究。未发现骨不连或明显畸形愈合情况。对肢体长度和股骨近端形态的随访评估显示，关节转子间距离和颈干角有轻微变化，但均无临床意义。同样，测量到肢体长度有轻微差异（范围为-11至+14毫米），未发现一致的过度生长模式。影像学随访未发现转子完全生长停滞的证据。弹性髓内钉似乎是治疗6至12岁儿童股骨干骨折的一种安全有效的方法。
