Clinkscales C M, Peterson H A
Mayo Clinic, Rochester, Minn, 55905, USA.
Orthopedics. 1997 Dec;20(12):1131-6. doi: 10.3928/0147-7447-19971201-07.
The effectiveness of several treatment modalities for isolated closed femur fractures in children ages 4 through 16 years is compared based on outcome (clinical results, morbidity, and parents' satisfaction) and cost. Between 1986 and 1993, 30 patients were treated. Treatment methods included immediate hip spica cast application, distal femoral skeletal traction pin to align the fracture followed by early hip spica cast incorporating the pin (6th day), in-hospital traction, primary external fixation, and primary intramedullary nailing. Average follow up was 4.1 years. Overall results were excellent with minimal morbidity for all treatment methods. Early application of hip spica cast with or without incorporation of the distal femoral traction pin required the fewest hospital days, the shortest time to union, and had the lowest overall cost. Complications, mainly malunion and femoral length discrepancy, however, were greater. Skeletal traction resulted in the longest hospital stay and was equal in cost to external fixation and intramedullary nailing. Primary external fixation appears most applicable in patients who are unlikely to tolerate early casting and who are at increased risk of avascular necrosis with femoral nailing. Patients treated with an intramedullary nail had the fewest complications. Age, size, and gender of patient, location and type of fracture, as well as social circumstances are all significant factors in choosing the optimal method of treatment.
基于治疗结果（临床疗效、发病率及家长满意度）和成本，比较了几种治疗方式对4至16岁儿童孤立性闭合性股骨骨折的疗效。1986年至1993年间，共治疗了30例患者。治疗方法包括立即应用髋人字石膏、股骨远端骨骼牵引针整复骨折后早期应用含针的髋人字石膏（第6天）、住院牵引、一期外固定和一期髓内钉固定。平均随访4.1年。所有治疗方法的总体结果均良好，发病率极低。早期应用髋人字石膏，无论是否使用股骨远端牵引针，住院天数最少，骨折愈合时间最短，总成本最低。然而，并发症（主要是畸形愈合和股骨长度差异）较多。骨骼牵引导致住院时间最长，成本与外固定和髓内钉固定相当。一期外固定似乎最适用于不耐受早期石膏固定且髓内钉固定发生股骨头缺血坏死风险增加的患者。接受髓内钉治疗的患者并发症最少。患者的年龄、体型和性别、骨折的部位和类型以及社会情况都是选择最佳治疗方法的重要因素。
