儿童股骨干骨折的规范化治疗

张立军

doi:10.3969/j.issn.2095-252X.2015.10.009

摘要：Femoral shaft fracture is the most common pediatric injury. Several methods of treatment of femoral shaft fracture can be used in children. In general, nonoperative therapy should be used in a 3 years or younger child, such as Pavlik harness, skin traction, spica casting, or spica casting followed skin traction. Femoral shaft fracture caused by birth trauma in neonate even with serious angulation deformity will turn to normal within one year after remolding. Operative therapy should be performed above 3 years old. Elastic Stabilized Intramedullary Nailing ( ESIN ) is the main operative treatment. ESIN with small incision and minimally invasive is suitable for transverse fracture and short oblique fracture. ESIN is not suitable for long oblique fracture, comminuted fracture and overweight ( > 45 kg ). The plate ifxation is suitable for inferior femoral lesser trochanter fracture and distal femoral metaphyseal fracture. The disadvantages of plate ifxation include the long incision, severe injury, and removal of the internal ifxator. The plate ifxation is decreasing in the modern treatment for the femoral shaft fracture in children. Submuscular bridge plating ifxation is applied to the long oblique fracture, spiral fracture, especially comminuted fracture. External ifxation is suitable for the infection of bone or soft tissue and open fracture. When the patient is older than 10 years ( or less ), especially with the weight of more than 50 kg, rigid locked intramedullary nail should be considered.