小児大腿骨頚部骨折の治療経験

Fracture of the Neck of the Femur in Children

　小児の大腿骨頚部骨折は，比較的稀な骨折である．今回，当教室の関連施設で治療された10症例10股について，骨折型，治療方法および治療成績について調査した．男児5例，女児5例で平均年齢は9.5歳であった．骨折型はDelbet-Colonna分類でⅠ型が1股，Ⅱ型が2股，Ⅲ型が5股，Ⅳ型が1股，転子下骨折が1股であった．即日手術を施行した症例が4股，牽引を施行した症例が6股であったが，最終的に7股が観血的内固定による手術療法となった．合併症は1股に大腿骨頭壊死を，1股に高度の頚部変形を認めた．

　Hip fractures in children are rare, accounting for＜1％ of all paediatric fractures. We reviewed 10 fractures of the femoral neck in 10 children. According to the Delbet-Colonna classification, 1 type Ⅰ fracture, 2 type Ⅱ fractures, 5 type Ⅲ fractures, 1 type Ⅳ fracture, and 1 subtrochanteric fracture were examined. The mean age at the time of fracture was 9.5 years (range, 2-14 years), and the average duration of follow-up after fracture was 16.4 months (range, 5-66 months). Four hips were immediately treated using surgical reduction and internal fixation with Kirschner wire and/or hip screws, and six hips were treated using traction. Three of the 6 hips treated using traction were subsequently operated on because of inadequate reduction. Complications occurred in two cases：one avascular necrosis and one severe malunion at the time of the final follow-up examination.