AAOS《儿童股骨干骨折治疗指南》解读

年度专稿·AAOS《儿童股骨干骨折治疗指南》解读【摘要】2009年美国矫形外科医师协会(M0$)制定了《儿童股骨干骨折治疗指南》，2015年根据新的指南制定标准对其进行了更新。新版指南根据现有文献未增加新的推荐建议，剔除了原指南保留的“尚不能确定的推荐意见”，保留了7项推荐建议：(1)对6个月的股骨干骨折患儿，推荐使用Pv1ik支具或髋人字石膏固定：(2)对(36个月的股骨干骨折患儿，应评估是否由虐待导致：(3)对6个月至5岁、短缩<2cm的股骨干骨折忠儿，推荐使用早期髋人字石膏固定或牵引后延期使用髋人字石膏固定：(4)制作石膏时，推荐使用防水村垫：(5)对5”11岁的股骨干骨折患儿，推荐选用弹性髓内钉治疗：(6)对11岁至骨骼成熟阶段儿童的股骨干骨折，推荐使用经转子开口的测性髓内钉、接骨板和弹性髓内钉治疗：()对儿室股骨干骨折患者推荐进行局部疼痛控制以改善围手术期舒适度。本文对新版指南进行了解读，以期为骨科医师诊治儿童股骨干骨折提供参考。【关键词】股骨干骨折：儿室Interpretation of Amer ican Academy of Or thopaedic Surgeons Clinical Practice Guideline on theTreatment of Pediatric Diaphyseal Femur Fractures Chen Wei Li Jia.Zhang Yingze.EmergencyCenter of Trauma.Department of Orthopedic Surgery.the Third Hspital of Hebei Medical Uhiversity.Or thopedic Research Institution of Hebei Province,Key Laboratory of Biomechanics of Hebei ProvinceShijiazhuang 050051.ChinaCorresponding author:Zhang Yingze.Email dryzzhang 126.com[Abstract]The original guideline on the Treatment of Pediatric Diaphyseal Femur Fractures(PDFF)was developed by the American Academy of Orthopaedic Sur geons AAOS)in 2009.and theidel ine was updated by AOS in 2015.In this reissue.all recommerdations in the original guidel ineidentified as inconclusive were removed with seven recommendations reserved and without newrecommendations added.The recommendations in the current guideline were listed as fol lows:(1)Childrenyounger than 36 months with PDFF should be evaluated for child abuse.(2)Pavlik harness or spica castmight be used for infants 6 months and younger with a PDFF.(3 Early spica casting or traction withdelayed spica casting oould be used for children aged from 6 months to 5 years with a PDFF with less than2 am of shortening.(4)Waterproof cast liners might be used for spica casts.(5)Flexible intramedul laryrailing might be sugested to treat children aged from 5 to 11 years with PDFF.(6)Rigid trochanteric entryriling submuscular plating.and flexible intramedul lary riling might be treatment cptions for children agedover 11 years to skeletal maturity with PDFF.(7)Regional pain management could be used for patientcomfort per ioperatively.This paper makes interpretation for this guidel ine with the aim to provide referencefor pediatric surgeans to select appropriate treatment methods for patients with PDFF.【Key words】Femur fracture;Children儿童股骨干骨折占儿童全部骨折的1.4%~案的选择与患儿年龄、体重、骨折部位、骨折类型和1.7%n-,其发病率高达19/10万人年[1，且男童发合并伤等有关刃，如何确定不同年龄段儿童股骨干病率高于女童41。儿童股骨干骨折可选用小夹板骨折的最佳治疗方案仍然存在争议。2009年美国固定、悬吊皮牵引、水平皮牵引、骨牵引、Pavlik支矫形外科医师协会(Amer i can Academy of具、髋人字石膏固定等保守方法治疗或外固定、弹性Orthopaedic Sur geons,AAOS)制定了《儿童股骨干骨髓内钉固定、接骨板固定等手术方法治疗。治疗方折治疗指南》【a】,该指南包含14个不同强度的推荐建议。根据新的指南制定标准，2015年AA0S循证医学专家组按照原指南文献检索策略和纳入排除标准审阅了新发表的文献，使用系统的循证医学方法对原指南进行更新以消除偏见、提高指南表述的明