目的:探讨闭合复位弹性髓内钉固定术(CR-ESIN)对股骨骨折患儿康复进程及关节功能的影响。方法:回顾性选取2024年4月~2025年6月至我院行内固定术治疗的102例股骨骨折患儿为研究对象,依据手术方案不同,将行CR-ESIN治疗的51例患儿列为CR-ESIN组,将剩余51例行传统切开复位接骨板内固定术(ORIF)治疗的患儿列为ORIF组,比较两组患儿的治疗情况、康复进程,手术并发症发生情况,关节功能恢复情况及内固定物取出阶段负担。结果:在不同手术方案下,CR-ESIN组的手术耗时、术中出血量、术后住院时间、支具使用时间、完全负重时间分别为(60.29±5.44)min、(50.52±5.49)mL、(6.22±1.34)d、(4.15±1.33)周、(6.81±1.34)周,均低于ORIF组[(76.33±8.29)min、(190.48±20.51)mL、(8.17±1.65)d、(6.32±1.48)周、(7.82±2.17)周](t=11.552,47.076,6.552,8.322,2.828;P<0.05)。CR-ESIN组的手术并发症发生率5.88%(3/51)低于ORIF组19.61%(10/51)(x2=4.320;P<0.05)。CR-ESIN组的髋关节前屈活动度、后伸活动度、儿童下肢功能量表(PODCI)评分分别为(132.44±22.52)°、(20.39±4.47)°、(75.14±6.29)分,均高于ORIF组[(120.28±20.37)°、(17.55±3.12)°、(70.31±5.36)分],术后双侧股骨长度差(1.52±0.39)cm低于ORIF组(3.08±0.44)cm(t=2.860,3.721,4.174,18.948;P<0.05)。CR-ESIN组的取出手术切口长度、取出手术耗时、取出手术出血量、再骨折率均低于ORIF组(t/x2=31.706,8.298,38.448,4.883;P<0.05)。结论:CR-ESIN能提高股骨骨折患儿手术效率并降低出血风险,与传统ORIF相比,此术式有利于加快患儿康复进程、降低术后并发症发生率、促进关节功能恢复并减轻内固定物取出阶段负担。
Objective:To explore the effects of closed reduction elastic intramedullary nail fixation (CR-ESIN) on the rehabilitation process and joint function of children with femoral fractures.Methods:A retrospective study was conducted on 102 children with femoral fractures who underwent internal fixation surgery in our hospital from April 2024 to June 2025. Based on different surgical plans, 51 children who underwent CR-ESIN treatment were included in the CR-ESIN group, and the remaining 51 children who underwent traditional open reduction plate internal fixation (ORIF) treatment were included in the ORIF group. The treatment status, rehabilitation process, incidence of surgical complications, joint function recovery, and burden during the removal of internal fixation materials were compared between the two groups of children.Results:Under different surgical plans, the surgical time, intraoperative blood loss, postoperative hospitalization time, brace use time, and complete weight-bearing time of the CR-ESIN group were (60.29 ± 5.44) min, (50.52 ± 5.49) mL, (6.22 ± 1.34) d, (4.15 ± 1.33) weeks, and (6.81 ± 1.34) weeks, lower than the ORIF group [(76.33 ± 8.29) min, (190.48 ± 20.51) mL, (8.17 ± 1.65) d, (6.32 ± 1.48) weeks, and (7.82 ± 2.17) weeks] (t=11.552,47.076,6.552,8.322,2.828; P<0.05). The incidence of surgical complications in the CR-ESIN group was 5.88% (3/51) lower than the ORIF group 19.61% (10/51) (x2=4.320; P<0.05). The hip flexion range of motion, extension range of motion, and PODCI scores of the CR-ESIN group were (132.44 ± 22.52) °, (20.39 ± 4.47) °, and (75.14 ± 6.29) points, higher than the ORIF group [(120.28 ± 20.37) °, (17.55 ± 3.12) °, and (70.31 ± 5.36) points]. The length difference between the bilateral femurs was (1.52 ± 0.39) cm, which was lower than the ORIF group (3.08 ± 0.44) cm (t=2.860,3.721,4.174,18.948; P<0.05). The length of the surgical incision, the duration of the extraction surgery, the amount of bleeding during the extraction surgery, and the rate of re fracture in the CR-ESIN group were all lower than the ORIF group (t/x2=31.706,8.298,38.448,4.883; P<0.05).Conclusion:CR-ESIN can improve the surgical efficiency and reduce the risk of bleeding in children with femoral fractures. Compared with traditional ORIF, this procedure is beneficial for accelerating the recovery process of children, reducing the incidence of postoperative complications, promoting joint function recovery, and reducing the burden of internal fixation removal stage.
论著
目的 探究四子散中药封包药熨在股骨骨折术后疼痛及肿胀中的临床疗效及安全性。方法 选取2024年6月—2025年5月婺源县人民医院骨科收治的60例股骨骨折术后患者, 随机分为观察组(30例,常规治疗+四子散中药封包药熨)与对照组(30例,常规治疗)。比较两组治疗前后疼痛评分(NRS-11)、肿胀程度评分、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平及不良事件发生率。结果 治疗前两组患者疼痛、肿胀评分、CRP、IL-6水平比较差异无统计学意义(P>0.05); 治疗1周后,观察组疼痛评分为(2.11±0.48)分、肿胀程度为(0.35±0.43)度、CRP为(12.23±3.12)mg/L、IL-6为(16.03±4.01)ng/L,均低于对照组的(3.54±0.56)分、(1.04±0.58)度、(24.31±4.51)mg/L、(23.19±6.75)ng/L,差异有统计学意义(P<0.001)。观察组与对照组均无发生不良事件。结论 四子散中药封包药熨可缓解股骨骨折术后疼痛及肿胀,安全性良好。
Objective To explore the clinical efficacy and safety of Sizi powder pack hot compress in the treatment of pain and swelling after femoral fracture surgery.Methods From June 2024 to May 2025, 60 patients after femoral fracture surgery were admitted to the Orthopedics Department of Wuyuan County People's Hospital and randomly divided into observation group(30 cases, conventional treatment+Sizi power pack hot compress)and control group(30 cases, conventional treatment). The pain score(NRS-11), swelling score, CRP,IL-6 levels and incidence of adverse events before and after treatment were compared between the two groups.Results There was no significant difference in pain and swelling scores between the two groups before treatment(P>0.05).After 1 week of treatment, the pain score(2.11±0.48), swelling score(0.35±0.43), CRP(12.23±3.12 mg/L), IL-6(16.03±4.01 ng/L)levels in the observation group were significantly lower than those in the control group(3.54±0.56, 1.04±0.58, 24.31±4.51 mg/L, 16.03+4.01 ng/L), and the difference was statistically significant(P<0.001).There were no adverse events in the observation group or the control group.Conclusions Sizi power pack hot compress can significantly alleviate the pain and swelling after femoral fracture surgery,and with good safety.