南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (11): 1971-1976.doi: 10.12122/j.issn.1673-4254.2023.11.19

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DelbetⅡ、Ⅲ型儿童及青少年髋部骨折的手术效果及并发症分析

孔 圳，钟 华，刘永强，孙永建，杨少铮，纪悦伦，吴伟平   

  1. 南方医科大学第五附属医院创伤骨科，广东 广州 510920；南方医科大学第三附属医院儿童骨科，广东 广州 510630
  • 出版日期:2023-11-20 发布日期:2023-12-08

Outcomes and complications of open versus closed reduction and internal fixation for Delbet type II and III hip fractures in children and adolescents

KONG Zhen, ZHONG Hua, LIU Yongqiang, SUN Yongjian, YANG Shaozheng, JI Yuelun, WU Weiping   

  1. Department of Traumatology and Orthopedics, Fifth Affiliated Hospital of Southern Medical University, Guangzhou 510920, China; Department of Pediatric Orthopedics, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
  • Online:2023-11-20 Published:2023-12-08

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摘要： 目的 探讨DelbetⅡ、Ⅲ型儿童及青少年髋部骨折的手术效果及并发症分析。方法 回顾性分析南方医科大学第五附属医院及第三附属医院2013年1月~2022年1月收治的DelbetⅡ、Ⅲ型儿童及青少年髋部骨折的患者资料。根据手术方式，分为闭合复位内固定组及切开复位内固定组。记录各组手术时间、术后愈合时间，Ratliff标准髋关节功能结果。统计骨骺早闭例数、股骨头坏死例数等并发症并作出对比分析。结果 共收集DelbetⅡ、Ⅲ型儿童及青少年髋部骨折患者42例，年龄2~15岁，平均8.19±3.23岁。其中男24例，女18例；Delbet骨折分型Ⅱ型22例、Ⅲ型20例。闭合复位内固定治疗19例，切开复位内固定治疗23例。所有患者随访时间13~84月，平均36.04±8.23月。闭合复位内固定的时间较切开复位内固定术少（P<0.05）。所有病例均获得满意愈合，两组病例愈合时间未见明显差异（P>0.05）。所有患者髋关节功能总体优良率90.48%。两组比较无明显差异（P>0.05）。共发生骨骺早闭7例，股骨头坏死3例，两组无明显差异（P>0.05）。结论 DelbetⅡ、Ⅲ型儿童及青少年髋部骨折的手术效果确切，若闭合复位可达到解剖复位，建议闭合复位内固定术治疗。骨骺早闭及股骨头坏死仍是儿童及青少年髋部骨折常见且严重并发症，应引起足够重视。

关键词: DelbetⅡ、Ⅲ型；儿童及青少年；髋部骨折；手术治疗

Abstract: Objective To compare the outcomes and complications of open versus closed reduction and internal fixation for Delbet type Ⅱ and Ⅲ hip fractures in children and adolescents. Methods We retrospectively analyzed the data of 42 patients with Delbet type Ⅱ (22 cases) and Ⅲ (20 cases) hip fractures (including 24 male and 18 female patients with a mean age of 8.19±3.23 years, range 2-15 years) admitted in the Fifth and Third Affiliated Hospital of Southern Medical University from January, 2013 to January, 2022. Nineteen of the patients received closed and 23 underwent open reduction and internal fixation. The operation time, postoperative healing time, and Ratliff standard hip function results were compared between the two groups, and the incidences of such complications as premature epiphyseal closure and femoral head necrosis were analyzed. Results All the patients were followed up for 13-84 months (mean 36.04 ± 8.23 months). The operation time of closed reduction and internal fixation was significantly shorter than that of open surgery (68.23±24.68 vs 119.71±32.75 min, P<0.05). All the patients showed good fracture healing after the operations with similar healing time between the two groups (3.32±0.31 vs 3.18±0.20 months, P>0.05). The rate of excellent and good hip joint function was 90.48% in the overall patients and showed no significant difference between the two groups (17/19 vs 21/23, P>0.05). The incidences of premature epiphyseal closure (3/19 in closed vs 4/23 in open reduction group, P>0.05) and femoral head necrosis (2/19 vs 1/23, P>0.05) were comparable between the two groups. Conclusions In children and adolescents, open reduction can achieve definite surgical effect for Delbet type II and III hip fractures, but closed reduction and internal fixation are recommended when anatomic reduction can be achieved. Premature epiphyseal closure and femoral head necrosis are common and serious complications of these fractures.

Key words: Delbet type Ⅱ and Ⅲ; children and adolescents; hip fractures; surgical treatment