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[目的]探讨应用钢针撬拨结合弹性髓内针治疗儿童难复性股骨近端骨折的临床疗效。[方法]回顾性分析2012年1月~2014年1月本院应用弹性髓内针结合钢针撬拨微创治疗儿童难复性股骨近端骨折18例;男13例,女5例;年龄4~13岁,平均6.7岁;对于儿童难复性的股骨近端骨折,由于近骨折端受肌肉牵拉常呈屈曲、外展和外旋移位,给骨折复位造成一定困难,通过临床实践和探索,本组在近骨折端的前外侧钻入直径3.0 cm的斯氏针,并透过对侧骨皮质,术者手持史氏针尾可灵活的控制近骨折端,使骨折复位的时间显著缩短,减少了反复复位的创伤。[结果]18例患者均获得随访,术后7~9周骨折端全部愈合,未见骨性异常;专科检查:双下肢等长,力线可,行走无明显跛行、颠簸步态;全麻下行内固定物取出术,应用股骨干骨折疗效评定标准系统评价,优17例,良1例。[结论]应用钢针撬拨加弹性髓内针微创治疗儿童难复性股骨近端骨折,不干预骨骺,不介入骨折端血肿,不剥离骨膜,为早期锻炼和康复创造了有力条件。
[Objective] To explore the clinical effect of using steel needle poking and elastic intramedullary nail in the treatment of proximal refractory femoral fractures in children. [Methods] Retrospective analysis from January 2012 to January 2014 in our hospital with elastic intramedullary nail combined with steel poking Minimally invasive treatment of children with refractory proximal femoral fractures in 18 cases; 13 males and 5 females; age 4 to 13 years old, an average of 6.7 years old; for children with refractory proximal femoral fractures, due to the proximal fracture by the muscle often flexed, outreach and external rotation shift, to fracture reduction caused some difficulties through clinical practice And exploration, the group near the anterior end of the fracture into the diameter of 3.0 cm Schnlued needle, and through the contralateral cortex, the surgeon’s hand can be controlled near the end of the needle fracture, the fracture reduction time significantly Shorten and reduce the trauma of repeated reset. [Results] Eighteen patients were followed up, all fractures were healed 7 to 9 weeks after operation, no bony abnormalities were found. The specialist examination was that the lower extremities were equal in length, the force line was OK, the patients had no obvious limping and jolting gait, and the general anesthesia Descending internal fixtures removed, the application of standard evaluation of the efficacy of femoral shaft fracture evaluation, excellent in 17 cases, good in 1 case. [Conclusion] Minimally invasive treatment of proximal refractory femoral fractures with steel poking and elastic intramedullary nailing does not interfere with the epiphysis and does not interfere with the hematoma at the fracture end. It does not peel off the periosteum and creates strong conditions for early exercise and rehabilitation.