前侧塑形钢板固定治疗儿童股骨转子部骨折.docVIP

前侧塑形钢板固定治疗儿童股骨转子部骨折[摘要] 目的 探索一种儿童股骨转子部骨折的新术式。方法 选取年龄3～14岁、股骨转子部骨折患者,手术取前外侧入路暴露骨折部位,骨折复位后于转子部及股骨干上端前侧放置适当塑形后的T型钢板,由前向后用5～7枚螺钉加压固定,术后髋人字石膏固定患肢2个月。结果 术后拍片示骨折复位及固定良好且螺钉未伤及骺板,随访所有11例患者术后骨折愈合及肢体功能恢复顺利。结论 前侧塑形钢板固定是儿童股骨转子部骨折手术治疗的理想选择。 [关键词] 股骨转子部骨折/儿童; 塑形钢板 [中图分类号] R683.42 [文献标识码] A [文章编号] 1673-9701(2009)23-47-02 Internal Fixation with Modified Steel Plate from Anterior Approach for Subtrochanteric Femoral Fractures in Children DING Xingpo WAN Fuan WANG Zhaoyin ZHANG Baofen Luoyang Orthopedic Hospital,Luoyang,Henan 471000,China [Abstract] ObjectiveTo discuss a new operative technique for subtrochanteric fractures of the femur in children. MethodsEleven children with subtrochanteric femoral fractures,aged from 3 to 14 years old,were treated surgically. In the course of operation,after reduction of fracture,the modified T-type steel plate was placed in the subtrochanteric femoral and the front side of femoral shaft top to fix fracture,followed by external fixation with manshaped hip spica cast. ResultsThe ideal reduction fixation was confirmed by postreduction film and all of the 11 cases recovered well in fractures and limb functions which were found by following up for 3 months to 5 years. ConclusionThe reduction and internal fixation of subtrochanteric femoral fractures by modified steel plate from anterior approach is a desirable operation technique. [Key Words]Subtrochanteric femoral fractures; Children; Modified steel plate 儿童股骨转子部骨折(包括股骨颈基底部骨折、转子间骨折和转子下骨折等)在临床上并不少见。由于儿童骨骼发育及创伤的特点造成该处骨折闭合复位及固定困难,而手术治疗又无合适术式及恰当的内固定材料,且容易造成股骨头及转子部骨骺损伤。我科从临床实践中总结出一种实用性较强的手术方法并改进了固定材料,采用转子部前侧塑形钢板固定的术式进行治疗,于 2004年2月～2009年2月共治疗该病11例,随访时间3个月～5年,效果满意。现将该治疗方法报道如下。 1 材料与方法 1.1 一般资料 本组共11例,男7例,女4例。年龄3～14岁(平均6岁3个月)。受伤原因:高处坠伤5例、摔伤2例、车祸4例。临床表现均为患肢疼痛、畸形、不能活动等,查体均有患肢屈曲、短缩等典型表现,其中3例为全身多发骨折。患者均为闭合性骨折,其中转子下骨折6例,转子间骨折3例,股骨颈基底部骨折2例。X线片显示骨折错位明显,近折端均有不同程度的屈曲、外展、外旋移位。 1.2 手术方法 采用股骨转子部前外侧入路、塑形钢板于股骨颈和转子部前侧固定。具体步骤:取转子部前方入路,切开皮肤、皮下及阔肌膜张肌外侧缘,将股直肌牵向内侧,切断前侧一部分股外侧肌起点并向后侧牵开,骨膜下