医学论文-儿童股骨干骨折不同年龄手术治疗的探讨.doc

医学论文-儿童股骨干骨折不同年龄手术治疗的探讨 ???????????? 作者：王亚生 李民 吕伟民 林丽珠 黄春菊 【关键词】? 骨折固定术 ??? 摘要：［目的］探讨儿童不同年龄股骨干骨折的三种内固定手术治疗效果。［方法］对47例儿童股骨干骨折的手术治疗方法及结果进行回顾性总结。［结果］髓内针固定4例、钢板螺钉固定29例、多枚螺钉固定14例。所有骨折手术后4～8周临床愈合，6～10个月(平均8个月)骨性愈合后取出内固定物。其中1例过早负重，钢板弯曲变形，再次手术10个月后骨性愈合。随访时间1～10a(平均5a)。［结论］髓内针固定操作简单，适用于年龄偏大儿童股骨上段，钢板固定适用于中段或下段骨折，多枚螺钉固定适用于长斜形或螺旋形股骨干骨折。 　　关键词：骨折固定术；股骨；儿童 　　Treatment of femoral shaft fracture of children in various ages 　　Abstract：［Objective］To discuss the treating effects of femoral shaft fractures of children in various ages. ［Method］The operative methods and results from 47 cases of femur shaft fractures of children were studied retrospectively. ［Result］Intramedullary pin fixations were performed in 4 cases, plate and screw fixations were performed in 29 cases, multiscrew fixations were performed in 14 cases. Clinical healings were achieved in four to eight weeks after operations in all cases. Internal fixation devices were taken out in six to ten months (averaged, 8 months) after bone union.? Loading exercises was started much so early in 1 case that the plate was bent, and bone union was acquired in 10 months after reoperation. Followup time ranged from 1 to 10 years (averaged, 5 years) in all cases.［Conclusion］Intramedullary pin fixation is simple to be handled, and is indicated for superior femoral segment of elder children; plate fixation is indicated for frames of middle piece or inferior segment; multiscrew is indicated for fractures of femoral shaft with spiral shape or long oblique shape. 　　Key words Fracture fixation; Femoral; Children 　　股骨干骨折在儿童骨折中较常见，以往多采用牵引、小夹板外固定等保守治疗，近年来随着创伤外科的发展及骨折治疗观念的更新，手术治疗已成为一种重要的治疗手段。从1993年以来，作者共收治儿童股骨干骨折47例，分别采用髓内针、钢板螺钉及多枚螺钉3???内固定方法进行治疗均取得满意效果。本文从儿童不同年龄阶段股骨干骨折手术治疗的意义及内固定物的选择方面展开讨论。 　　1? 临床资料 　　1．1 一般资料 　　本组男37例，女10例，年龄10～16岁，平均14岁。新鲜骨折32例，陈旧骨折15例，中上段骨折6例，中段骨折28例，中下段骨折13例，闭合性骨折43例，开放性骨折4例、5例为粉碎性骨折，14例为长斜或螺旋形骨折。重要合并伤：骨盆骨折2例，胫骨骨折3例，同侧大腿小腿皮肤挫裂伤1例，同侧尺桡双骨折3例，致伤原因：车祸12例，骑自行车跌伤26例，高处坠落9例。 　　1.2? 不同年龄阶段内固定方法及术后处理 　　1.2.1? 髓内针固定?????? 　　共4例，年龄在1