Objective: To explore the effectiveness of rigid interlocking nails through the tip of the greater trochanter for fixation of femur shaft fracture in adolescent.
Methods: A retrospective analysis was made on the clinical data of 23 adolescents with femoral shaft fractures treated between June 2011 and June 2015. Of 23 cases, 19 were male and 4 were female, aged from 13 years and 6 months to 17 years (mean, 15.2 years), weighed from 40 to 77 kg (mean, 53.5 kg). The causes were traffic accident injury in 13 cases, sports injury in 7 cases, and falling injury in 3 cases. Fracture located at the proximal 1/3 in 6 cases, middle 1/3 in 10 cases, and distal 1/3 in 7 cases; fracture was typed as transverse in 10 cases, oblique in 6 cases, spiral in 1 case, and comminuted in 6 cases. The course of disease was 3-17 days (mean, 6.2 days). At last follow-up, the leg length discrepancy, femoral neck shaft angle, femoral neck diameter, and articulotrochanteric distance (ATD) were measured on the X-ray films.
Results: Wounds healed in all patients, and no infection occurred. All patients were followed up 15-36 months (mean, 26.5 months). The patients had no pain and had normal gait, without lameness. The X-ray films showed bone healing at 5-13 months (mean, 6.5 months). No nonunion, delayed union, malunion of more than 5 °, or rotational deformity occurred. The removal time of internal fixations was 12-24 months (mean, 19.5 months) after operation. No heterotopic ossification, re-fracture, proximal femoral deformity, or femoral head necrosis occurred during follow-up. Two patients had early epiphyseal closure of greater trochanter, which had no impact on gait; leg-length inequality of less than 1 cm was observed in 2 cases. At last follow-up, the neck shaft angle, femoral neck diameter, and ATD of normal and affected sides were (131.7±6.3) and (132.9±7.8)°, (34.1±3.2) and (33.9±3.8) mm, and (27.8±9.2) and (26.5±8.5) mm, showing no significant difference between two sides ( t=-0.24, P=0.86; t=0.18, P=0.92; t=1.03, P=0.49).
Conclusion: It is a reliable and effective method to use rigid interlocking nails inserted through the tip of the greater trochanter for the fixation of femur shaft fracture in adolescent.
目的: 探讨大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折的疗效。.
方法: 2011 年 6 月—2015 年 6 月，采用闭合复位大粗隆顶点开口顺行带锁髓内钉治疗 23 例青少年股骨干骨折。其中男 19 例，女 4 例；年龄 13 岁 6 个月～17 岁，平均 15.2 岁。体质量 40～77 kg，平均 53.5 kg。致伤原因：交通事故伤 13 例，运动伤 7 例，摔伤 3 例。骨折位置：股骨干上 1/3 6 例，中 1/3 10 例，下 1/3 7 例。骨折类型：横形骨折 10 例，斜形骨折 6 例，螺旋形骨折 1 例，粉碎性骨折 6 例。受伤至手术时间 3～17 d，平均 6.2 d。末次随访时于双下肢全长 X 线片，测量双下肢长度、颈干角、股骨颈直径、股骨头最高点平面与股骨大粗隆顶点平面间距离（articulotrochanteric distance，ATD）。.
结果: 患者术后切口均Ⅰ期愈合，无感染等早期并发症发生。23 例均获随访，随访时间 15～36 个月，平均 26.5 个月。术后患者均无疼痛，步态正常，无跛行，均恢复日常生活及运动。X 线片复查示，骨折均愈合，临床愈合时间 5～13 个月，平均 6.5 个月；均无骨折不愈合、延迟愈合及超过 5°的畸形愈合、旋转畸形发生。术后 12～24 个月取出内固定物，平均 19.5 个月。随访期间无异位骨化及再骨折发生，无股骨近端发育畸形及股骨头缺血性坏死发生。2 例术后大粗隆骨骺早闭，但步态无影响；2 例双下肢不等长，但双下肢差值<1 cm；均无需手术处理。末次随访时健、患侧颈干角分别为（131.7±6.3）、（132.9±7.8）°，股骨颈直径分别为（34.1±3.2）、（33.9±3.8）mm，ATD 分别为（27.8±9.2）、（26.5±8.5）mm，比较差异均无统计学意义（ t=–0.24， P=0.86； t=0.18， P=0.92； t=1.03， P=0.49）。.
结论: 大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折固定可靠，是一种有效的手术方法。.
Keywords: Rigid interlocking nail; adolescent; femur shaft fracture; greater trochanter.