Lu Ming,Yang Zheng,You Haifeng,et al.Midterm follow-up surgical outcomes of pediatric Pilon fracture[J].Journal of Clinical Pediatric Surgery,2019,18(07):594-599.[doi:10.3969/j.issn.1671-6353.2019.07.015]
超关节外固定架结合有限内固定手术治疗儿童型Pilon骨折的中期随访结局分析
- Title:
- Midterm follow-up surgical outcomes of pediatric Pilon fracture
- Keywords:
- Fractures; Bone; External Fixators; Orthopedic Procedures
- 分类号:
- R726.8;R687.4+3
- 摘要:
- 目的 由于Pilon骨折在骨骺未闭合的儿童及青少年中十分罕见，因此本研究旨在探讨儿童型Pilon骨折的治疗方法和治疗规律，提高医生对这种特殊类型骨折的认识，制定恰当的治疗方案，降低并发症发生率，最大程度恢复踝关节功能。方法 收集北京积水潭医院小儿骨科2011年1月至2017年1月收治的21例儿童型Pilon骨折患儿的临床资料，年龄为8岁2个月至14岁3个月，随访时间为1年7个月至7年8个月，中位年龄11岁3个月，中位随访时间4年3个月。根据Letts提出的儿童Pilon骨折分型，本组中Ⅰ型2例、Ⅱ型6例、Ⅲ型13例。所有病例合并腓骨骨折，其中12例还合并距骨骨折。结果 7例行单纯切开复位内固定；13例因软组织严重肿胀或难以维持复位的踝关节脱位，行关节外固定架结合有限内固定；1例因损伤较轻行石膏固定保守治疗。最终随访结果根据Helfet标准进行判定，其中10例为优、8例为良、3例为差，总体优良率为85.7%。3例出现距骨坏死，4例出现因胫骨远端骺早闭导致的踝内外翻畸形；无一例出现骨髓炎及深部感染；1例因皮肤坏死行局部皮瓣转移手术，愈合良好。结论 对于伴有踝关节脱位或严重软组织损伤的儿童型Pilon骨折患儿，超关节外固定架联合有限内固定可作为首选的治疗方法。
- Abstract:
- Objective Pilon fractures are rare in children and skeleton-immature adolescents.The purpose of this study was to summarize the surgical efficacies of pediatric Pilon fractures and enhance the understanding of this special type of fractures so as to explore the formulation of appropriate treatment,reduce the incidence of complications and maximize the recovery of ankle function.Methods From January 2011 to January 2017,21 cases of pediatric Pilon fracture were collected.The average age was 135 (98-171) months and the mean follow-up period 51 (19-92) months.According to the Letts classification,the clinical types were Ⅰ(n=2),Ⅱ(n=6) and Ⅲ(n=13).All patients had concurrent fibular fractures and 12 cases concurrent talus fractures.Results Seven patients underwent open reduction and internal fixation and 13 cases underwent ankle spanning external fixation plus limited internal fixation due to severe soft tissue swelling or difficulty of maintaining the reduction of ankle dislocation.One case was treated conservatively with cast immobilization because of mild injury.According to the Helfet’s criteria,the outcomes were excellent (n=10),good (n=8) and poor (n=3) at the final follow-up.Excellent-to-good outcomes were observed in 85.7% cases.Talus osteonecrosis occurred in 3 cases and 4 cases suffered from growth arrest of distal tibia resulting in ankle varus or valgus deformity.There was no onset of osteomyelitis or deep infection.One case undergoing local skin flap transfer due to skin necrosis healed well.Conclusion For pediatric Pilon fracture with ankle dislocation or severe soft tissue injury,ankle spanning external fixator plus limited internal fixation is a preferred option.
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备注/Memo
收稿日期:2018-11-25。
通讯作者:郭源,Email:gy0902@sina.com