弹性髓内针技术治疗2133例儿童四肢长骨骨折的并发症发生情况

摘要

目的 探讨弹性髓内针技术治疗儿童四肢长骨骨折的术后并发症发生情况.方法 回顾性分析南京医科大学附属儿童医院骨科2005年6月至2017年12月收治的接受弹性髓内针手术治疗且符合纳入和排除标准的2 133例四肢长骨骨折患儿的临床资料.男性1 191例,女性942例;年龄(5.7±3.1)岁(范围:1岁11个月至14岁).手术采用闭合复位弹性髓内针固定1 866例,术中采用小切口辅助复位弹性髓内针267例.统计分析术后并发症的发生情况.结果 2 133例患儿中,骨折发生在股骨603例,胫骨311例,腓骨8例,肱骨219例,尺桡骨992例.术后并发症主要包括针尾激惹反应(62例),骨折对位对线不齐(21例),髓内针变形或成角畸形(11例),肢体短缩(7例),关节活动受限(14例),医源性神经损伤(4例),肌腱损伤(2例),取针困难(14例),骨皮质劈裂(4例),骨延迟愈合(8例),骨不愈合(1例),内、外翻畸形(6例),骨骺损伤(5例),弹性髓内针外露(6例),针尾金属碎屑残留(2例).结论 弹性髓内针技术治疗儿童四肢长骨骨折术后出现的并发症不容忽视,掌握重要的生物力学特性、熟悉局部解剖特点及避免明显技术错误可减少其术后并发症的发生.%Objective To summarize the clinical data of elastic stable intramedullary nailing (ESIN) in the treatment of long bone fracture of children in a single medical center,and to analyze the problems occurred after the ESIN surgery and corresponding solutions.Methods A retrospective analysis was conducted regarding the clinical data of 2 133 pediatric long bone fractures conforming to inclusion and exclusion criteria from June,2005 to December,2017 in Department of Orthopedics,Children's Hospital of Nanjing Medical University.There were 1 191 boys and 942 girls,aged from 23 months to 14 years with mean age of (5.7 ± 3.1) years.There were 1 866 cases treated with closed reduction with ESIN,while 267 cases were treated with small incision assisted reduction with ESIN.Postoperative problems have been statistically analyzed.Results There were altogether 2 133 children,including 603 cases of femur,311 cases of tibia,8 cases of fibula,219 cases of humerus,and 992 cases of ulna/radius.The postoperative complications mainly consist of 62 cases of needle tail irritation reaction,21 cases of misalignments of fracture alignment,11 cases of intramedullary nail deformity or angular deformity,7 cases of limb shortening,14 cases of limited joint activity,4 cases of nerve injury,2 cases of tendon injury,14 cases of difficult nail removal,4 cases of cortical cleavage,8 cases of delayed union,1 case of nonunion,6 cases of varus/valgus deformity,5 cases of epiphyseal injury,6 cases of ESIN exposure,and 2 cases of metal debris of ESIN'end.Conclusions The complications of treatment for children with long bone fractures by ESIN cannot be ignored.To master the important biomechanical properties,to get familiar with the local anatomy and to avoid obvious technical errors can reduce the occurrence of postoperative complications.