Objective: To investigate curative effects of elastic stable intramedullary nails in the treatment of stable and unstable fractures of femoral shaft in children and to guide its clinical application. Methods: From January 2008 to October 2010,44 children with femoral shaft fractures were treated,including 24 boys and 20 girls,ranging in age from 5 to 12 years, with an average of 7.4 years. Based on the fractures stable or not, the patients were divided into stable fractures group (group S) and unstable fractures group (group U). All the children received the same operation to fix broken femoral with elastic stable intramedullary nails and some children received traction or small splint protection after operation when reduction and fixation were considered unsatisfied or his/her weight beyond 30 kg. During the followed-up, the healing time, irritation of the soft tissue (ache, cyst, et al), malunion (angulation above 5 degree in X-ray), limb shortening or lengthening and excellent and good rate were observed. Results:All the patients were followed up,and the duration ranged from 5 to 19 months,with an average of 13 months. All the fractures were healed at the latest follow-up. The average healing time was 10.2 weeks (ranges,8 to 14 weeks). The incidence rate of malunion was 23.8% in group U and the average angulation was 9 degree(6 to 12 degree),which was higher than those of patients in the group S(0%). The average healing time, limb shortening or lengthening, irritation of the soft tissue and the excellent and good rate between two groups had no significance differences,which were (10.6±1.3) vs. (9.9+1.2) weeks,0 vs. 3 cases,3 vs. 1 case and 2 vs. 4 cases respectively. In the group U,among 5 patients had malunion,4 patients were not treated with traction or small splint protection, and the incidence was higher than those who were given traction or small splint protection. Conclusion: Both the stable and unstable femoral shaft fractures in children treated with elastic stable intramedullary nails can receive well short-term curative effects. If given certain postoperative protection like as traction or small splint,the malunion incidence can be reduced.%目的:探讨弹性髓内钉治疗稳定及不稳定性儿童股骨干骨折的疗效,指导其临床应用.方法:选择我院2008年1月至2010年10月的儿童股骨干骨折44例,男24例,女20例,年龄5～12岁,平均7.4岁.根据骨折稳定性分为2组,稳定性骨折组(S组)23例,不稳定性骨折组(U组)21例.所有患儿行弹性髓内钉手术固定治疗,对复位固定不满意或体重＞30 kg者,术后给予牵引或小夹板保护.随访观察2组骨折愈合时间,有无钉尾激惹症状(疼痛、囊肿等),愈合时X线片上有无畸形(＞5°内外翻或前后成角),患肢短缩或延长及优良率等.结果:所有患者获随访,时间5～19个月,平均13个月,末次随访时骨折全部愈合,平均愈合时间10.2周(8～14周).U组畸形愈合5例,平均成角9°(6°～12°),发生率比S组(0例)高(P＜0.05).S组骨折愈合时间平均(10.6±1.3)周,U组(9.9±1.2)周；S组患肢缩短0例,U组3例,平均缩短1.0 cm(0.5～1.8 cm)；S组患肢延长3例,平均延长1.1 cm(0.5～2.1 cm),U组1例,延长0.6 cm;S组钉尾激惹2例,U组4例；S组优20例,良2例,差1例,U组优15例,良3例,差3例.以上指标2组比较差异无统计学意义(P＞0.05).U组中,5例畸形愈合中4例发生于术后无牵引或小夹板组,发生率较术后牵引或小夹板组高,差异有统计学意义(P＜0.05).结论:弹性髓内钉对儿童股骨干稳定及不稳定性骨折的短期疗效均较好,术后给予牵引或小夹板保护可以减少不稳定性骨折畸形愈合的发生.
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