中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2013年
7期
515-518
,共4页
股骨骨折%骨折固定术,内%股骨头坏死
股骨骨摺%骨摺固定術,內%股骨頭壞死
고골골절%골절고정술,내%고골두배사
Femoral fractures%Fracture fixation,internal%Femur head necrosis
目的 评估儿童股骨颈骨折超过24 h后手术治疗的结果及并发症,探讨影响股骨头坏死发生的因素.方法 2008年至2012年21例股骨颈骨折患儿,男16例(17髋),女5例,年龄5～15岁,平均11岁.参照Delbet分型,Ⅰ型(经骺板骨折)2髋,Ⅱ型(经颈骨折)9髋,Ⅲ型(股骨颈基底骨折)8髋,Ⅳ型(股骨颈转子间骨折)3髋.受伤到手术的时间3～90 d,平均14.8d.9髋采用闭合复位内固定,13髋采用切开复位内固定.治疗结果采用Ratliff标准来评分.结果 随访时间12～44个月,平均20个月,治疗结果中优18髋(81.8％),良3髋(13.6％),差1髋(4.5％).股骨头坏死的发生率为18％,出现股骨头坏死的病例结果均为良或差.切开复位组有3例股骨头坏死(23.1％),闭合复位组有1例股骨头坏死(11.1％),两者无显著性差异(P＞0.05).年龄、骨折分型与股骨头坏死无显著关联(P＞0.05).结论 股骨头坏死是影响延迟固定治疗儿童股骨颈骨折结果的主要因素.闭合复位内固定有利于降低儿童股骨颈骨折股骨头坏死的发生率.
目的 評估兒童股骨頸骨摺超過24 h後手術治療的結果及併髮癥,探討影響股骨頭壞死髮生的因素.方法 2008年至2012年21例股骨頸骨摺患兒,男16例(17髖),女5例,年齡5～15歲,平均11歲.參照Delbet分型,Ⅰ型(經骺闆骨摺)2髖,Ⅱ型(經頸骨摺)9髖,Ⅲ型(股骨頸基底骨摺)8髖,Ⅳ型(股骨頸轉子間骨摺)3髖.受傷到手術的時間3～90 d,平均14.8d.9髖採用閉閤複位內固定,13髖採用切開複位內固定.治療結果採用Ratliff標準來評分.結果 隨訪時間12～44箇月,平均20箇月,治療結果中優18髖(81.8％),良3髖(13.6％),差1髖(4.5％).股骨頭壞死的髮生率為18％,齣現股骨頭壞死的病例結果均為良或差.切開複位組有3例股骨頭壞死(23.1％),閉閤複位組有1例股骨頭壞死(11.1％),兩者無顯著性差異(P＞0.05).年齡、骨摺分型與股骨頭壞死無顯著關聯(P＞0.05).結論 股骨頭壞死是影響延遲固定治療兒童股骨頸骨摺結果的主要因素.閉閤複位內固定有利于降低兒童股骨頸骨摺股骨頭壞死的髮生率.
목적 평고인동고골경골절초과24 h후수술치료적결과급병발증,탐토영향고골두배사발생적인소.방법 2008년지2012년21례고골경골절환인,남16례(17관),녀5례,년령5～15세,평균11세.삼조Delbet분형,Ⅰ형(경후판골절)2관,Ⅱ형(경경골절)9관,Ⅲ형(고골경기저골절)8관,Ⅳ형(고골경전자간골절)3관.수상도수술적시간3～90 d,평균14.8d.9관채용폐합복위내고정,13관채용절개복위내고정.치료결과채용Ratliff표준래평분.결과 수방시간12～44개월,평균20개월,치료결과중우18관(81.8％),량3관(13.6％),차1관(4.5％).고골두배사적발생솔위18％,출현고골두배사적병례결과균위량혹차.절개복위조유3례고골두배사(23.1％),폐합복위조유1례고골두배사(11.1％),량자무현저성차이(P＞0.05).년령、골절분형여고골두배사무현저관련(P＞0.05).결론 고골두배사시영향연지고정치료인동고골경골절결과적주요인소.폐합복위내고정유리우강저인동고골경골절고골두배사적발생솔.
Objective To evaluate the results and the factors affecting the development of avascular necrosis of the femoral head in children who underwent surgery for femoral neck fractures after a 24-hour delay.Methods We reviewed the results of 21 children (16 boys,5 girls; range 5 to 15 years with an average of 11 years) who were operated on after the first 24 hours for femoral neck fractures.By Delbet's classification,there was 2 cases of type Ⅰ,9 of type Ⅱ,8 of type Ⅲ and 3 of type Ⅳ.The mean duration from trauma to surgery was 14.8 days (range 3 to 90 days).Internal fixation was performed following closed (n =9) or open (n =13) reduction.The results were assessed using the Ratliff criteria at the end of a mean follow-up of 20 months (range 12 to 44 months).The patients were evaluated with respect to age,type of fracture,complications,treatment and avascular necrosis.Results The results were good in 18(82％),fair in 3 (14％),and poor in 1 patient (4％).The most frequent complication was avascular necrosis (18 ％),which was significantly related to poor outcome (P＜0.05).One (11％) hip developed avascular necrosis in closed reduction group and 3 (23％) hip developed avascular necrosis in open reduction group.There was no statistical difference between the two groups.No significant differences were found with regard to age and the type of fracture between patients with and without avascular necrosis (P＞0.05).Conclusions Outcomes of delayed in fracture fixation of the femoral neck are primarily affected by osteonecrosis of the femoral head.Closed reduction and internal fixation does seem to decrease the incidence of osteonecrosis.
