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目的探讨克氏针引导下中空螺钉内固定治疗儿童股骨颈干骺端骨折疗效及优越性。方法通过择期或急诊对骨折进行闭合手法复位,部分病例复位不成功者,采用有限切开复位,C臂机透视下复位满意后从股骨粗隆下1-2cm向干骺端及股骨颈、头穿入克氏针,C型臂再次透视调整克氏针位置与深度,在克氏针引导下拧入中空螺钉行骨折端加压固定。对于中空螺钉远端螺纹未能超过骨折线者,不能起到骨折端加压作用者,采用保留克氏针,远端在中空螺钉帽处折弯挂靠螺钉帽外沿,并剪除多余部分,术后采用皮牵引3周。结果所有病例均获得随访,时间3-18个月,平均随访时间为9.4个月,其中8例中空螺钉远端螺纹能超过骨折线行骨折端加压固定,3例患儿仅有1枚中空螺钉远端螺纹能超过骨折线行骨折端加压固定,3例中空螺钉远端螺纹未能超过骨折线,行保留克氏针至术后6-8周后拔除。所有干骺端骨折愈合良好,术后按Ratliff标准评价:优7例,良2例,可3例,优良率为75%,MRI证实出现股骨头坏死并行髓芯减压带肌蒂骨瓣移植术。结论克氏针引导下中空螺钉内固定技术能达到微创,减少了软组织的损伤和骨折端血运的影响,减少了股骨头坏死的机率,中空螺钉行骨折端加压固定,有利于骨折愈合,螺钉未穿过骨骺线,对骺端生长发育影响小。
Objective To investigate the curative effect and superiority of Kirschner wire-guided hollow screws in the treatment of metaphyseal fractures of the femoral neck in children. Methods Elective or emergency treatment of fractures closed reduction, some cases of unsuccessful reduction, using a limited open reduction, C arm machine under the satisfaction of reset satisfaction from the femoral tuberosity 1-2cm to the metaphysis and femoral neck, head Into the Kirschner wire, C-arm again perspective adjustment Kirschner wire position and depth, under the guidance of Kirschner wire screws into the fracture line compression fixation. For the distal screw screw thread failed to exceed the fracture line who can not play the role of the fracture pressure, the use of retained Kirschner wire, the distal screw in the hollow screw cap bent at the outer edge of the screw cap, and cut off the excess part of surgery Skin traction after 3 weeks. Results All the cases were followed up for 3-18 months with an average follow-up time of 9.4 months. Among them, the distal thread of 8 cases of hollow screw could surpass the fracture line and the compression end was fixed. Only 1 hollow The distal screw thread can be more than the fracture line fracture fixation, 3 cases of distal screw thread failed to exceed the fracture line, the line to keep Kirschner wire after 6-8 weeks after removal. All metaphyseal fractures healed well. According to Ratliff criteria after operation, the results were excellent in 7 cases, good in 2 cases and fair in 3 cases. The excellent and good rate was 75%. MRI showed that the core decompression and musculocutaneous bone flap transplantation Surgery. Conclusion The Kirschner wire guided hollow screw fixation can achieve minimal invasion, reduce the damage of soft tissue and the blood supply at the fracture end, reduce the chance of femoral head necrosis. The hollow screw can be used to fix the fractures and promote fracture healing , The screw did not cross the epiphyseal line, the growth and development of the metaphysis little effect.