CAJ | 학술논문

目的探讨儿童股骨颈骨折的治疗方法及其疗效.方法回顾性分析1986年1月至2007年12月收治的23例儿童股骨颈骨折患儿,男13例,女10例;年龄3～16岁,平均12.8岁.前10年的13例均为高能量损伤;近10年中5例为滑倒跌伤,对其中3例测量身体质量指数和骨矿物质密度.无移位骨折4例,采用非手术治疗;手术治疗19例,其中闭合复位15例、切开复位4例.手术距受伤时间小于24 h者15例(平均11.2 h),超过24 h者4例(1 d后1例、5 d后1例、7 d后1例、3周后1例).闭合复位中关节穿刺减压11例,关节囊切开减压4例.复位采用1～3枚空心螺钉内固定18例,角钢板固定1例.术后以髋关节支具保护.定期随访X线及MRI,评估骨折愈合及股骨头坏死情况.结果全部患儿均获随访,随访时间13个月～11年,平均4年.保守治疗的4例患儿,术后出现髋外翻1例、肢体短缩畸形1例.手术治疗的19例患儿,18例骨折复位好,一期愈合,其中轻度髋内翻1例、髋外翻1例;1例复位欠佳患儿出现骨折延迟愈合,经再次手术翻修和植骨后愈合.无一例患儿发生股骨头坏死.受伤超过24 h接受手术治疗的4例患儿,1例发生延迟愈合.轻微外伤患儿的身体质量指数和骨矿物质密度均属于偏低或极低范围.结论儿童股骨颈骨折应早期诊断、早期治疗,争取受伤24 h内采用闭合或切开复位及钛制空心螺钉内固定,配合关节囊穿刺或切开减压,术后以髋关节支具保护.儿童股骨颈骨折受伤机制的改变可能与儿童身体质量指数和骨矿物质密度改变有关.
목적 탐토인동고골경골절적치료방법급기료효.방법 회고성분석1986년1월지2007년12월수치적23례인동고골경골절환인,남13례,녀10례;년령3～16세,평균12.8세.전10년적13례균위고능량손상;근10년중5례위활도질상,대기중3례측량신체질량지수화골광물질밀도.무이위골절4례,채용비수술치료;수술치료19례,기중폐합복위15례、절개복위4례.수술거수상시간소우24 h자15례(평균11.2 h),초과24 h자4례(1 d후1례、5 d후1례、7 d후1례、3주후1례).폐합복위중관절천자감압11례,관절낭절개감압4례.복위채용1～3매공심라정내고정18례,각강판고정1례.술후이관관절지구보호.정기수방X선급MRI,평고골절유합급고골두배사정황.결과 전부환인균획수방,수방시간13개월～11년,평균4년.보수치료적4례환인,술후출현관외번1례、지체단축기형1례.수술치료적19례환인,18례골절복위호,일기유합,기중경도관내번1례、관외번1례;1례복위흠가환인출현골절연지유합,경재차수술번수화식골후유합.무일례환인발생고골두배사.수상초과24 h접수수술치료적4례환인,1례발생연지유합.경미외상환인적신체질량지수화골광물질밀도균속우편저혹겁저범위.결론 인동고골경골절응조기진단、조기치료,쟁취수상24 h내채용폐합혹절개복위급태제공심라정내고정,배합관절낭천자혹절개감압,술후이관관절지구보호.인동고골경골절수상궤제적개변가능여인동신체질량지수화골광물질밀도개변유관.
Objective To investigate the therapeutic results of femoral neck fractures in pediatric patients in our center and review the literature. Methods Authors conducted a computerized search of med-ical records to identify all children with femoral neck fractures treated at our institution from January 1986 to December 2007. Records were reviewed to determine injury mechanism, fracture type (Delbet's classification: type Ⅰ to Ⅳ), displacement, age, treatment and complication. Twenty-three patients with a mean age of 12.8 years (range, 3-16 years) with femoral neck fractures were identified and 3 cases with cerebral palsy were excluded. There were 13 male patients and 10 female patients. Nineteen cases underwent operation, includ-ing closed reduction for 15 cases, and open reduction for other 4 cases. Four cases were treated conservation. The mean follow-up was 4 years (range, 1.1-11 years). We studied timing of surgery, type of fixation, and quality of reduction with respect to the primary outcome measure-radiographic evidence of union and avascu-lar necrosis. The BMI and BMD data of latest 3 patients were obtained due to specially trivial injury mecha-nism. Results Eighteen of 19 operated cases have satisfied healing of fracture in good to excellent posi-tions. One patient had Haidukewych classification of fair reduction with delayed union and required hip screw revision and bone grafting. One had coxa varus, one had coxa valgus. Four patients were treated more than 24 hours after injury, including the patient who had delayed union. The mean time to fixation for the remaining patients was 11.2 hours after injury. The BMI and BMD data of 3 patients were abnormal when compared with children of the same age group. Conclusion The study shows that closed or open reduction, decompression and cannulated screw stable internal fixation for femoral neck fractures in children should be a standard treatment which leads to satisfactory results without occurrence of avascular necrosis.