Objective: To compare the effectiveness of titanium elastic nail (TEN) and locking compression plate fixation in treating femoral subtrochanteric fracture in older children.
Methods: Between April 2015 and September 2016, 35 older children (aged 7-13 years) with femoral subtrochanteric fractures were treated, the clinical data were retrospectively reviewed. TEN fixation was used in 19 cases (group A) and locking compression plate fixation in 16 cases (group B). There was no significant difference in age, gender, sides, fracture causes, type of fracture, and time from injury to operation between 2 groups ( P>0.05). The fluoroscopy times, operation time, intraoperative blood loss, fracture healing time were recorded and compared between 2 groups. The limb function was evaluated according to the Sanders scores and Flynn et al. outcome score.
Results: All the patients were followed up 6-24 months (mean, 11.46 months). The operation time, intraoperative blood loss, and fracture healing time of group A were significantly less than those of group B, but the fluoroscopy times of group A was significantly more than that of group B ( P<0.05). All the fractures were healed, no breakage of screw, infection of deep tissue, nerve injury, osteonecrosis of the femoral head, or other complication occurred. At last follow-up, according to the Sanders scores, the results were excellent in 14 cases, good in 4 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 12 cases, good in 3 cases, and fair in 1 case in group B with an excellent and good rate of 93.75%; showing no significant difference between 2 groups ( χ2=0.400, P=0.980). According to the Flynn et al. outcome score, the results were excellent in 13 cases, good in 5 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 11 cases, good in 3 cases, and fair in 2 cases in group B with an excellent and good rate of 87.50%; showing no significant difference between 2 groups ( χ2=0.748, P=0.688).
Conclusion: Both TEN and locking compression plate have satisfactory outcomes for treating pediatric femoral subtrochanteric fractures. TEN method has minimally trauma, security, and faster fracture healing when compared with locking compression plate.
目的: 比较弹性髓内钉（titanium elastic nail，TEN）及股骨锁定加压钢板治疗大龄儿童股骨粗隆下骨折的临床疗效。.
方法: 回顾性分析 2015 年 4 月—2016 年 9 月收治的 35 例股骨粗隆下骨折大龄（年龄 7～13 岁）患儿临床资料，其中 19 例采用闭合复位 TEN 内固定治疗（A 组），16 例采用切开复位锁定加压钢板内固定治疗（B 组）。两组患儿年龄、性别、侧别、致伤原因、骨折分型、受伤至手术时间等一般资料比较差异无统计学意义（ P>0.05），具有可比性。记录术中透视次数、手术时间、术中失血量、骨折愈合时间等。末次随访时，根据 Sanders 评分标准对髋关节功能进行评价，根据 Flynn 等提出的下肢骨折评价标准进行疗效评价。.
结果: 两组患者均获随访，随访时间 6～24 个月，平均 11.46 个月。A 组患者手术时间、术中失血量、骨折愈合时间均显著少于 B 组，但术中透视次数多于 B 组，差异均有统计学意义（ P<0.05）。所有患儿骨折均愈合，无内固定失效、深部组织感染、神经损伤、股骨头坏死等其他严重并发症发生。末次随访时，根据 Sanders 评分标准评价患侧髋关节功能，A 组优 14 例、良 4 例、中 1 例，优良率 94.74%；B 组优 12 例、良 3 例、中 1 例，优良率 93.75%；两组比较差异无统计学意义（ χ2=0.400， P=0.980）。根据 Flynn 评价标准，A 组优 13 例、良 5 例、可 1 例，优良率 94.74%；B 组优 11 例、良 3 例、可 2 例，优良率 87.50%；两组比较差异无统计学意义（ χ2=0.748， P=0.688）。.
结论: 对于儿童股骨粗隆下骨折，采用 TEN 及锁定加压钢板均可获得满意疗效；与锁定加压钢板相比，TEN 治疗儿童股骨粗隆下骨折具有微创、安全、骨折愈合迅速等优点。.
Keywords: Titanium elastic nail; femoral subtrochanteric fracture; locking compression plate; older children.