临床小儿外科杂志2024，Vol.23Issue(4)：361-366,6.DOI:10.3760/cma.j.cn101785-202308009-011
经正前方切口入路治疗儿童股骨颈骨折的疗效分析
Experience of treating femoral neck fractures in children through a direct anterior approach
南国新 1陈家樑 1陈嘉辉 1许伟森 1蔡文全 2郑健 2周颖聪 1李娟 1李云隆 1莫启能 1田震1
作者信息
- 1. 广东医科大学东莞市儿童医院小儿骨科,东莞 523326||东莞市第八人民医院小儿骨科,东莞 523326
- 2. 重庆医科大学附属儿童医院骨科,重庆 400014
- 折叠
摘要
Abstract
Objective To explore a simple and mini-invasive surgical approach for femoral neck fracture in children.Methods From February 2017 to January 2023,retrospective review was performed for the rele-vant clinical data of 13 children with femoral neck fractures undergoing incisional reduction,compression screw or Kirschner pin fixation at Chongqing Children's Hospital and Dongguan Children's Hospital.There were a total of 14 sides.One epileptic child had bilateral femoral neck fractures occurring sequentially 6 months apart.There were 10 boy and 3 girls with a mean age of 6.5(3.2-8.2)year.Delbet type was Ⅰ(n=2),Ⅱ(n=9,10 sides)and Ⅲ(n=2).All cases exhibited significant fracture displacement or angular deformity pre-operation.Operation was performed under general anesthesia.After location was located under a C-arm,target location was marked and direct anterior approach(DAA)adopted.After incising skin and subcutaneous fat,proximal lateral side of rectus femoris muscle was bluntly dissected and proximal end of muscle retracted medially,exposing an-terior part of hip joint capsule.For type Ⅰ/Ⅱ fracture,joint capsule was opened and assisted traction plus re-duction were performed under a direct vision.Then after inserting guide wires and confirming a correct position,two hollow compression screws with a diameter of 4.0 mm were used for fixation.For type Ⅰ fractures,3-4 Kirschner needle with a diameter of 2.0 mm was utilized for fixation.After surgery,they were immobilized with a hip brace or cast for 6 weeks and then removed.At Month 3 post-operation,weight-bearing activities at affect-ed side were avoided and monthly follow-ups conducted.At Month 6 post-operation,internal fixation was re-moved and MRI performed for eliminating the possibility of avascular necrosis of femoral head.Collect informa-tion on incision length,operative time,intraoperative bleeding,reduction and complications in all patients.Re-sults The incision length ranged from 3.0 to 3.5 cm with a mean length of 3.2 cm.No muscle tissue was in-cised intraoperatively.Average operative duration was 36(33-42)min.Intraoperative hemorrhage had a mean volume of 12.3(12-20)mL.Postoperative radiography confirmed anatomical realignment in all cases.Internal fixation was removed at a mean time of 6.8(6-12)month.One child of type Ⅰ fracture resulting in ischemic necrosis of the femoral head was identified through MRI after Kirschner's pin removal.Conclusions DAA is suitable for treating pediatric femoral neck fractures.This approach may provide a distinct exposure of fracture site,cause mini-trauma and does not disrupt the integrity of anterior muscles.Allowing for fast postoperative functional recovery,it has a low incidence of complications,making it a simple and feasible surgical approach for femoral neck fractures.关键词
股骨颈骨折/外科手术/骨折固定术,内/治疗结果/儿童Key words
Femoral Neck Fractures/Surgical Procedures,Operative/Fracture Fixation,Internal/Treatment Outcome/Child引用本文复制引用
南国新,陈家樑,陈嘉辉,许伟森,蔡文全,郑健,周颖聪,李娟,李云隆,莫启能,田震..经正前方切口入路治疗儿童股骨颈骨折的疗效分析[J].临床小儿外科杂志,2024,23(4):361-366,6.
