Abstract：
BACKGROUND: Complications following operative treatment of pediatric femoral neck fractures include nonunion, coxa vara, and avascular necrosis (AVN). Proximal femoral locking plates (PFLPs) provide a fixed-angle construct that may reduce the rates of coxa vara, but their use in pediatric femoral neck fractures has not been studied. The purpose of this study was to evaluate rates of union, coxa vara, and AVN in traumatic pediatric femoral neck fractures treated with PFLP or cannulated screws (CS).
METHODS: We retrospectively reviewed all traumatic, nonpathologic Delbet II/III femoral neck fractures in patients below 18 years of age treated with PFLP or CS. All cases had ≥6 months of radiographic follow-up to evaluate for osseous union and AVN. Changes in proximal femoral alignment were determined by measuring injured and contralateral femoral neck-shaft angle and articulotrochanteric distance (ATD) between 6 and 12 months postoperatively.
RESULTS: Forty-two patients were identified with mean age at surgery of 10.7±2.9 years (range 3.3 to 16.3 years) and mean follow-up of 36±27 months. Sixteen patients (38%) underwent PFLP fixation, whereas 26 patients (62%) underwent CS fixation. When compared with the CS cohort, the PFLP cohort had a greater proportion of males (87.5% vs. 50%, P =0.02) and Delbet III fractures (68.8% vs. 15.4%, P <0.001). There was no difference between PFLP and CS cohorts with respect to rates of union (81% vs. 88%, respectively, P =0.66), AVN (25% vs. 35%, respectively, P =0.73), or secondary surgery (62% vs 62%, P =0.95). There was no significant difference in neck-shaft angle between injured and contralateral hips in those patients treated with PFLP ( P =0.93) or CS ( P =0.16). However, the ATD was significantly decreased in hips treated with CS compared with the contralateral hip (18.4±4.6 vs. 23.3±4.2 mm, P =0.001), with no significant difference in the PFLP group ( P =0.57).
CONCLUSIONS: This study suggests that the use of a PFLP in Delbet II/III femoral neck fractures does not appear to significantly increase nonunion rates or AVN and maintains anatomic ATD when compared with screw fixation.
METHODS: Level III-therapeutic study.
METHODS: We retrospectively reviewed all traumatic, nonpathologic Delbet II/III femoral neck fractures in patients below 18 years of age treated with PFLP or CS. All cases had ≥6 months of radiographic follow-up to evaluate for osseous union and AVN. Changes in proximal femoral alignment were determined by measuring injured and contralateral femoral neck-shaft angle and articulotrochanteric distance (ATD) between 6 and 12 months postoperatively.
RESULTS: Forty-two patients were identified with mean age at surgery of 10.7±2.9 years (range 3.3 to 16.3 years) and mean follow-up of 36±27 months. Sixteen patients (38%) underwent PFLP fixation, whereas 26 patients (62%) underwent CS fixation. When compared with the CS cohort, the PFLP cohort had a greater proportion of males (87.5% vs. 50%, P =0.02) and Delbet III fractures (68.8% vs. 15.4%, P <0.001). There was no difference between PFLP and CS cohorts with respect to rates of union (81% vs. 88%, respectively, P =0.66), AVN (25% vs. 35%, respectively, P =0.73), or secondary surgery (62% vs 62%, P =0.95). There was no significant difference in neck-shaft angle between injured and contralateral hips in those patients treated with PFLP ( P =0.93) or CS ( P =0.16). However, the ATD was significantly decreased in hips treated with CS compared with the contralateral hip (18.4±4.6 vs. 23.3±4.2 mm, P =0.001), with no significant difference in the PFLP group ( P =0.57).
CONCLUSIONS: This study suggests that the use of a PFLP in Delbet II/III femoral neck fractures does not appear to significantly increase nonunion rates or AVN and maintains anatomic ATD when compared with screw fixation.
METHODS: Level III-therapeutic study.
摘要：
背景：小儿股骨颈骨折手术治疗后的并发症包括骨不连，Coxavara,和血管坏死（AVN）。股骨近端锁定板（PFLP）提供了一个固定角度的结构，可以降低髋内翻的发生率，但它们在小儿股骨颈骨折中的应用尚未被研究。这项研究的目的是评估工会率，Coxavara,和AVN在使用PFLP或空心螺钉（CS）治疗的创伤性小儿股骨颈骨折中。
方法：我们回顾性回顾了所有创伤，使用PFLP或CS治疗的18岁以下患者的非病理性DelbetII/III型股骨颈骨折。所有病例均接受≥6个月的影像学随访，以评估骨性愈合和AVN。通过测量术后6至12个月的受伤和对侧股骨颈轴角度和关节转子距离（ATD）来确定股骨近端排列的变化。
结果：42例患者的平均年龄为10.7±2.9岁（范围为3.3至16.3岁），平均随访时间为36±27个月。16例（38%）患者行PFLP固定术，而26例（62%）患者接受CS固定术。与CS队列相比，PFLP队列的男性比例更高(87.5%vs.50%,P=0.02）和DelbetIII骨折（68.8%vs.15.4%,P<0.001)。PFLP和CS队列在结合率方面没有差异(81%与88%,分别,P=0.66),AVN（25%与35%,分别,P=0.73),或二次手术(62%对62%，P=0.95）。在接受PFLP（P=0.93）或CS（P=0.16）治疗的患者中，受伤臀部和对侧臀部之间的颈轴角度没有显着差异。然而,与对侧髋关节相比，接受CS治疗的髋关节的ATD显着降低（18.4±4.6vs.23.3±4.2mm,P=0.001),在PFLP组中无显著差别(P=0.57)。
结论：这项研究表明，与螺钉固定相比，在DelbetII/III型股骨颈骨折中使用PFLP似乎不会显着增加骨不连率或AVN，并维持解剖ATD。
方法：III级治疗性研究。
方法：我们回顾性回顾了所有创伤，使用PFLP或CS治疗的18岁以下患者的非病理性DelbetII/III型股骨颈骨折。所有病例均接受≥6个月的影像学随访，以评估骨性愈合和AVN。通过测量术后6至12个月的受伤和对侧股骨颈轴角度和关节转子距离（ATD）来确定股骨近端排列的变化。
结果：42例患者的平均年龄为10.7±2.9岁（范围为3.3至16.3岁），平均随访时间为36±27个月。16例（38%）患者行PFLP固定术，而26例（62%）患者接受CS固定术。与CS队列相比，PFLP队列的男性比例更高(87.5%vs.50%,P=0.02）和DelbetIII骨折（68.8%vs.15.4%,P<0.001)。PFLP和CS队列在结合率方面没有差异(81%与88%,分别,P=0.66),AVN（25%与35%,分别,P=0.73),或二次手术(62%对62%，P=0.95）。在接受PFLP（P=0.93）或CS（P=0.16）治疗的患者中，受伤臀部和对侧臀部之间的颈轴角度没有显着差异。然而,与对侧髋关节相比，接受CS治疗的髋关节的ATD显着降低（18.4±4.6vs.23.3±4.2mm,P=0.001),在PFLP组中无显著差别(P=0.57)。
结论：这项研究表明，与螺钉固定相比，在DelbetII/III型股骨颈骨折中使用PFLP似乎不会显着增加骨不连率或AVN，并维持解剖ATD。
方法：III级治疗性研究。
