Применение эластичных стабильных интрамедуллярных стержней для лечения переломов длинных костей у пациентов с незрелым скелетом

Введение. Лечение переломов длинных костей у детей – сложная и быстро развивающаяся область травматологии. Традиционно гипсование и консервативные методы играли ключевую роль в лечении переломов у пациентов с незрелым скелетом. Тем не менее, хирургический подход неуклонно развивался в течение последних четырех десятилетий, и было опубликовано все больше данных, подтверждающих преимущества методов фиксации над консервативными методами.

Цель данного описательного обзора – показать, как инновации в ортопедической хирургии изменили обоснование лечения переломов длинных костей у детей и подростков с акцентом на хирургические методы, в частности, на эластичные стабильные интрамедуллярные стержни (ESIN).

Материалы и методы. Авторы стремились описать основные тенденции в лечении переломов длинных костей у детей и выявить их особенности и трудности, а также выбрать лучший стандарт лечения.

Результаты. Внедрение ESIN значительно повлияло на тенденции в лечении переломов верхних и нижних конечностей у детей. В целом, по сравнению с консервативными методами, преимущества ESIN заключаются в минимальной инвазивности, сокращении сроков пребывания в стационаре, обеспечении первичного сращения костей, возможности ранней мобилизации пациента и постепенного увеличения нагрузки на конечность. Также указанный метод обусловливает достижение хорошего результата с незначительным показателем осложнений. Более того, гибкий гвоздь может использоваться как закрытый редукционный инструмент.

Выводы. Независимо от выполняемой техники ключевыми позициями остаются: 1) адекватная оценка травмы, которую необходимо лечить; 2) выявление основных характеристик пациента; 3) плюсы и минусы каждой техники; 4) возможные осложнения.

1. Fractures in children: epidemiology and activity-specific fracture rates / P.H. Randsborg, P. Gulbrandsen, J. Saltytė Benth, E.A. Sivertsen, O.L. Hammer, H.F. Fuglesang, A. Arøen // J. Bone Joint Surg. Am. 2013. Vol. 95, No 7. P. e42. DOI: 10.2106/JBJS.L.00369.

2. Epidemiology of fractures in children and adolescents / E.M. Hedström, O. Svensson, U. Bergström, P. Michno // Acta Orthop. 2010. Vol. 81, No 1. P. 148-153. DOI: 10.3109/17453671003628780.

3. Hoverboard injuriesin children and adolescents: results of a multicenterstudy / P. Hosseinzadeh, C. Devries, R.E. Saldana, S.A. Scherl, L.M. Andras, M. Schur, F.D. Shuler, M. Mignemi, A. Minaie, A. Chu, E.D. Fornari, S.L. Frick, M.S. Caird, A.I. Riccio, K. Pierz, C. Plakas, M.J. Herman // J. Pediatr. Orthop. B. 2019. Vol. 28, No 6. P. 555-558. DOI: 10.1097/BPB.0000000000000653.

4. Conservative interventions for treating diaphyseal fractures of the forearm bones in children / V. Madhuri, V. Dutt, A.D. Gahukamble, P. Tharyan // Cochrane Database Syst. Rev. 2013. No 4. CD008775. DOI: 10.1002/14651858.CD008775.pub2.

5. Alternatives to Traditional Cast Immobilization in Pediatric Patients / E.D. Shirley, K.J. Maguire, A.L. Mantica, R.W. Kruse // J. Am. Acad. Orthop. Surg. 2020. Vol. 28, No 1. P. e20-e27. DOI: 10.5435/JAAOS-D-18-00152.

6. Outcome of Conservative Versus Surgical Treatment of Humeral Shaft Fracture in Children and Adolescents: Comparison Between Nonoperative Treatment (Desault's Bandage), External Fixation and Elastic Stable Intramedullary Nailing / F. Canavese, L. Marengo, M. Cravino, V. Giacometti, B. Pereira, A. Dimeglio, C. Origo, A. Andreacchio // J. Pediatr. Orthop. 2017. Vol. 37, No 3. P. e156-e163. DOI: 10.1097/BPO.0000000000000843.

7. Evaluation of upper extremity function of displaced diaphyseal humeral fractures in children treated by elastic stable intramedullary nailing: preliminary results / F. Canavese, L. Marengo, A. Samba, M. Rousset, M. Mansour, A. Andreacchio, A. Dimeglio // J. Pediatr. Orthop. B. 2016. Vol. 25, No 5. P. 399-405. DOI: 10.1097/BPB.0000000000000318.

8. Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing / L. Marengo, M. Rousset, M. Paonessa, S. Vanni, A. Dimeglio, A. Samba, A. Andreacchio, F. Canavese // Eur. J. Orthop. Surg. Traumatol. 2016. Vol. 26, No 5. P. 453-459. DOI: 10.1007/s00590-016-1758-y.

9. Functional outcome of displaced intercondylar fractures of the humerus in children and adolescents / L. Marengo, A. Andreacchio, F. Alberghina, A. Dimeglio, F. Canavese // J. Pediatr. Orthop. B. 2018. Vol. 27, No 2. P. 121-127. DOI: 10.1097/BPB.0000000000000476.

10. Metaizeau J.P. L’ostéosynthèse chez l’enfant: Techniques et indications // Rev. Chir. Orthop. Reparatrice Appar. Mot. 1983. Vol. 69, No 7. P. 495- 511.

11. Lascombes P., Haumont T., Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents // J. Pediatr. Orthop. 2006. Vol. 26, No 6. P. 827-834. DOI: 10.1097/01.bpo.0000235397.64783.d6.

12. Elastic stable intramedullary nailing of femoral shaft fractures in children / J.N. Ligier, J.P. Metaizeau, J. Prévot, P. Lascombes // J. Bone Joint Surg. Br. 1988. Vol. 70, No 1. P. 74-77. DOI: 10.1302/0301-620X.70B1.3339064.

13. Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning /J.P. Metaizeau, P. Lascombes,J.L. Lemelle, D. Finlayson, J. Prevot // J. Pediatr. Orthop. 1993. Vol. 13, No 3. P. 355-360. DOI: 10.1097/01241398-199305000-00015.

14. Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with precurved tip and shaft nails / P. Lascombes, A. Nespola, J.M. Poircuitte, D. Popkov, A. de Gheldere, T. Haumont, P. Journeau // Orthop. Traumatol. Surg. Res. 2012. Vol. 98, No 4. P. 369-375. DOI: 10.1016/j.otsr.2011.11.011.

15. Complications of titanium and stainless steel elastic nail fixation of pediatric femoral fractures / E.J. Wall, V. Jain, V. Vora, C.T. Mehlman, A.H. Crawford // J. Bone Joint Surg. Am. 2008. Vol. 90, No 6. P. 1305-1313. DOI: 10.2106/JBJS.G.00328.

16. Femoralshaft fracturesin children treated with early spica cast /A.G. Martinez, N.C. Carroll,J.F. Sarwark, L.S. Dias,A.S. Kelikian, G.A. Sisson Jr. // J. Pediatr. Orthop. 1991. Vol. 11, No 6. P. 712-716. DOI: 10.1097/01241398-199111000-00002.

17. Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children / H.R. Shemshaki, H. Mousavi, G . Salehi, M.A. Eshaghi // J. Orthop. Traumatol. 2011. Vol. 12, No 1. P. 45-48. DOI: 10.1007/s10195-011-0128-0.

18. Reeves R.B., Ballard R.I., Hughes J.L. Internal fixation versus traction and casting of adolescent femoral shaft fractures // J. Pediatr. Orthop. 1990. Vol. 10, No 5. P. 592-595. DOI: 10.1097/01241398-199009000-00004.

19. Femoral shaft fractures in children: traction and casting versus elastic stable intramedullary nailing / K.E. Buechsenschuetz, C.T. Mehlman, K.J. Shaw, A.H. Crawford, E.B. Immerman // J. Trauma. 2002. Vol. 53, No 5. P. 914-921. DOI: 10.1097/00005373-200211000-00017.

20. FinancialAnalysis ofClosed Femur Fracturesin 3-to 6-Year-OldsTreatedWith Immediate SpicaCastingVersusIntramedullary Fixation /R.B. Lewis, O. Hariri, M.E. Elliott, C.H. Jo, B.A. Ramo // J. Pediatr. Orthop. 2019. Vol. 39, No 2. P. e114-e119. DOI: 10.1097/BPO.0000000000001253.

21. AmericanAcademy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture / M.S. Kocher, E.L. Sink, R.D. Blasier, S.J. Luhmann, C.T. Mehlman, D.M. Scher, T. Matheney, J.O. Sanders, W.C. Watters 3rd, M.J. Goldberg, M.W. Keith, R.H. Haralson 3rd, C.M. Turkelson, J.L. Wies, P. Sluka, R. McGowan; American Academy of Orthopaedic Surgeons // J. Bone Joint Surg. Am. 2010. Vol. 92, No 8. P. 1790-1792. DOI: 10.2106/JBJS.J.00137.

22. Pediatric tibia and femur fractures in patients weighing more than 50 kg (110 lb): mini-review on current treatment options and outcome / A. Andreacchio, F. Alberghina, L. Marengo, F. Canavese // Musculoskelet. Surg. 2019. Vol. 103, No 1. P. 23-30. DOI: 10.1007/s12306-018-0570-8.

23. Elastic stable intramedullary nailing of tibial shaft fractures in children / J. Griffet, J. Leroux, N. Boudjouraf, A. Abou-Daher, T. El Hayek // J. Child. Orthop. 2011. Vol. 5, No 4. P. 297-304. DOI: 10.1007/s11832-011-0343-5.

24. Flexible titanium nailing for the treatment of the unstable pediatric tibial fracture / T. O'Brien, D.S. Weisman, P. Ronchetti, C.P. Piller, M.. Maloney // J. Pediatr. Orthop. 2004. Vol. 24, No 6. P. 601-609. DOI: 10.1097/00004694-200411000-00001.

25. Intraoperative Issues and Clinical and Radiographic Outcomes of Femur Fractures Treated With Flexible Nails: A Comparison of Cases Utilizing Skeletal Traction and a Traction Table to Cases Using Manual Traction Only / F. Canavese, F. Alberghina, M. Cravino, M. Paonessa, A. Dimeglio, A. Andreacchio // J. Pediatr. Orthop. 2020. Vol. 40, No 8. P. e676-e682. DOI: 10.1097/BPO.0000000000001538.

26. Wang Y., Lobstein T. Worldwide trends in childhood overweight and obesity // Int. J. Pediatr. Obes. 2006. Vol. 1, No 1. P. 11-25. DOI: 10.1080/17477160600586747.

27. Pediatric obesity and traumatic lower-extremity long-bone fracture outcomes / I.C. Backstrom, P.A. MacLennan, J.R. Sawyer, A.T. Creek, L.W. Rue 3rd, S.R. Gilbert // J. Trauma Acute Care Surg. 2012. Vol. 73, No 4. P. 966-971. DOI: 10.1097/TA.0b013e31825a78fa.

28. Hunter J.B. The principles of elastic stable intramedullary nailing in children // Injury. 2005. Vol. 36, No Suppl. 1. P. A20-A24. DOI: 10.1016/j.injury.2004.12.009.

29. Malunion following flexible intramedullary nails for tibial and femoral fractures in adolescents / D.E. Deakin, H. Winter, P. Jain, C.E. Bache // J. Child. Orthop. 2010. Vol. 4, No 6. P. 571-577. DOI: 10.1007/s11832-010-0300-8.

30. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more / F. Canavese, L. Marengo, A. Andreacchio, M. Mansour, M. Paonessa, M. Rousset, A. Samba, A. Dimeglio // Int. Orthop. 2016. Vol. 40, No 12. P. 2627-2634. DOI: 10.1007/s00264-016-3259-3.

31. Displaced tibia shaft fractures in children treated by elastic stable intramedullary nailing: results and complications in children weighing 50 kg (110 lb) or more / L. Marengo, M. Paonessa, A. Andreacchio, A. Dimeglio, A. Potenza, F. Canavese // Eur. J. Orthop. Surg. Traumatol. 2016. Vol. 26, No 3. P. 311-317. DOI: 10.1007/s00590-015-1729-8.

32. Titanium elastic nails for pediatric tibial shaft fractures / W.N. Sankar, K.J. Jones, B. David Horn, L. Wells // J. Child. Orthop. 2007. Vol. 1, No 5. P. 281-286. DOI: 10.1007/s11832-007-0056-y.

33. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome / L.A. Moroz, F. Launay, M.S. Kocher, P.O. Newton, S.L. Frick, P.D. Sponseller, J.M. Flynn // J. Bone Joint Surg. Br. 2006. Vol. 88, No 10. P. 1361-1366. DOI: 10.1302/0301-620X.88B 10.17517.

34. Pombo M.W., Shilt J.S. The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails // J. Pediatr. Orthop. 2006. Vol. 26, No 3. P. 364-370. DOI: 10.1097/01.bpo.0000203005.50906.41.

35. Extra-articular proximal femur fractures in children and adolescents treated by elastic stable intramedullary nailing / F. Alberghina, A. Andreacchio, M. Cravino, M. Paonessa, F. Canavese // Int. Orthop. 2019. Vol. 43, No 12. P. 2849-2856. DOI: 10.1007/s00264-019-04379-x.

36. Displaced distal femur metaphyseal fractures: clinical and radiographic outcome in children aged 6-16 years treated by elastic stable intramedullary nailing / F. Canavese, F. Alberghina, A. Dimeglio, V. Pavone, A. Andreacchio // J. Pediatr. Orthop. B. 2020. DOI: 10.1097/BPB.0000000000000820.

37. Elastic stable intramedullary nailing forseverely displaced distal tibial fracturesin children / K. Shen, H. Cai, Z. Wang, Y. Xu // Medicine (Baltimore). 2016. Vol. 95, No 39. P. e4980. DOI: 10.1097/MD.0000000000004980.

38. Outcome of displaced distal tibial metaphyseal fractures in children between 6 and 15 years of age treated by elastic stable intramedullary nails / M. Cravino, F. Canavese, V. de Rosa, L. Marengo,A. Samba, M. Rousset, M. Mansour Khamallah,A.Andreacchio // Eur.J. Orthop. Surg. Traumatol. 2014. Vol. 24, No 8. P. 1603-1608. DOI: 10.1007/s00590-013-1402-z.

39. Proximal humerus fractures in children and adolescents / Y. Lefèvre, P. Journeau, A. Angelliaume, A. Bouty, E. Dobremez // Orthop. Traumatol. Surg. Res. 2014. Vol. 100, No 1 Suppl. P. S149-S156. DOI: 10.1016/j.otsr.2013.06.010.

40. Proximal humerus fractures in the pediatric population: a systematic review / S. Pahlavan, K.D. Baldwin, N.K. Pandya, S. Namdari, H. Hosalkar // J. Child. Orthop. 2011. Vol. 5, No 3. P. 187-194. DOI: 10.1007/s11832-011-0328-4.

41. Outcome of Displaced Fractures of the Distal Metaphyseal-Diaphyseal Junction of the Humerus in Children Treated With Elastic Stable Intramedullary Nails / L. Marengo, F. Canavese, M. Cravino, V. de Rosa, M. Rousset, A. Samba, M. Mansour, A. Andreacchio // J. Pediatr. Orthop. 2015. Vol. 35, No 6. P. 611-616. DOI: 10.1097/BPO.0000000000000340.

42. Fractures of the distal humeral metaphyseal-diaphyseal junction in children / R.S. Fayssoux, L. Stankovits, M.E. Domzalski, J.T. Guille // J. Pediatr. Orthop. 2008. Vol. 28, No 2. P. 142-146. DOI: 10.1097/BPO.0b013e3181653af3.

43. Long-term results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children / C.D. Peterlein, T. Modzel, L. Hagen, S. Ruchholtz, A. Krüger // Medicine (Baltimore). 2019. Vol. 98, No 11. P. e14743. DOI: 10.1097/MD.0000000000014743.

44. Risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing / B. Han, Z. Wang, Y. Li, Y. Xu, H. Cai // Int. Orthop. 2019. Vol. 43, No 9. P. 2093-2097. DOI: 10.1007/s00264-018-4184-4.

45. Functional outcome of displaced radial head fractures in children treated by elastic stable intramedullary nailing / C. Guyonnet, A. Martins, L. Marengo, M. Mansour, M. Rousset, A. Samba, A. Dimeglio, F. Canavese // J. Pediatr. Orthop. B. 2018. Vol. 27, No 4. P. 296-303. DOI: 10.1097/BPB.0000000000000502.

46. Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning /J.P. Metaizeau, P. Lascombes,J.L. Lemelle, D. Finlayson, J. Prevot // J. Pediatr. Orthop. 1993. Vol. 13, No 3. P. 355-360. DOI: 10.1097/01241398-199305000-00015.

47. Functional and radiological outcome in patients with acute Monteggia fracture treated surgically: a comparison between closed reduction and external fixation versus closed reduction and elastic stable intramedullary nailing / Z. Yuan, H. Xu, Y. Li, J. Li, Y. Liu, F. Canavese // J. Pediatr. Orthop. B. 2020. Vol. 29, No 5. P. 438-444. DOI: 10.1097/BPB.0000000000000645.

48. Leet A.I., Pichard C.P., Ain M.C. Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications? // J. Bone Joint Surg. Am. 2005. Vol. 87, No 12. P. 2609-2613. DOI: 10.2106/JBJS.D.02019.

49. Pandya N.K., Edmonds E.W., Mubarak S.J. The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures // J. Child. Orthop. 2011. Vol. 5, No 6. P. 439-447. DOI: 10.1007/s11832-011-0374-y.

50. Fractures and refractures after femoral locking compression plate fixation in children and adolescents / T. Becker, D. Weigl, E. Mercado, K. Katz, E. Bar-On // J. Pediatr. Orthop. 2012. Vol. 32, No 7. P. e40-e46. DOI: 10.1097/BPO.0b013e318264496a.

51. Kong H., Sabharwal S. External fixation for closed pediatric femoral shaft fractures: where are we now? // Clin. Orthop. Relat. Res. 2014. Vol. 472, No 12. P. 3814-3822. DOI: 10.1007/s11999-014-3554-5.

52. MacNeil J.A., Francis A., El-Hawary R. A systematic review of rigid, locked, intramedullary nail insertion sites and avascular necrosis of the femoral head in the skeletally immature // J. Pediatr. Orthop. 2011. Vol. 31, No 4. P. 377-380. DOI: 10.1097/BPO.0b013e3182172613.