Cai Wenquan,Su Yuxi,Qin Jiaqiang,et al.Clinical efficacy of distal tibial fractures in children with external fixation with joint[J].Journal of Clinical Pediatric Surgery,2021,20(07):677-680.[doi:10.12260/lcxewkzz.2021.07.016]
跨关节外固定架治疗儿童胫骨远端骨折疗效观察
- Title:
- Clinical efficacy of distal tibial fractures in children with external fixation with joint
- Keywords:
- Tibial Fractures; Fracture Fixation; Treatment Outcome; Child
- 分类号:
- R726.834.23;R726.8
- 摘要:
- 目的 探讨跨关节外固定架治疗儿童胫骨远端骨折的临床疗效。方法 选取重庆医科大学附属儿童医院2010年1月至2016年12月于门诊手法复位失败的胫骨远端闭合性骨折患者49例为研究对象，其中男34例，女15例，年龄8.5~16.2岁，平均12.3岁。右踝骨折39例，左踝骨折10例。手术在C型臂X光机监视下进行，行踝关节轴向牵引，根据骨折类型对患者足部进行内旋或外旋，达到解剖复位后行跨关节外固定架固定，远端螺钉固定于距骨颈与跟骨，近端固定于胫骨近端。如骨折断端嵌有软组织阻碍复位或牵引复位不成功，则行切开复位。术中行X线检查，确定骨折是否解剖复位，骨折间隙<2 mm为复位成功。术后无需石膏固定，术后1周开始下床负重，术后3周活动踝关节，并采用AOFAS评分系统评估整体疗效。结果 49例中，闭合复位成功30例，有限切开复位固定19例。随访12~90个月，平均38个月。末次X线片检查提示49例均骨性愈合，未发现关节面不平整现象，无踝关节内外翻和短缩畸形，术后5~8周拆除外固定架。AOFAS评分系统判定结果：优39例，良9例，一般1例。患者均能正常参加体育活动。结论 跨关节外固定架治疗儿童胫骨远端骨折整体疗效满意，能有效恢复踝关节关节面的平整，避免踝关节僵硬，是治疗儿童胫骨骨折的可选方法之一。
- Abstract:
- Objective To explore the clinical efficacy of external fixation with joint for distal tibia fractures in children.Methods A total of 49 children with closed distal tibia fractures undergoing manual reduction from January 2010 to December 2016 were enrolled.There were 34 boys and 15 girls with an average age of 12.3 (8.5-16.2) Years.The involved side was right (n=39) and left (n=10).The operation was performed under the surveillance of X-ray machine.Ankle joint was axially pulled.According to the type of fracture,internal or external rotation of foot was achieved.After anatomical reduction,external fixation with joint was fixed.The distal screw of stent was fixed on talus neck and calcaneus and proximal end fixed on proximal tibia.If fracture ends were embedded with soft tissue obstruction,open reduction was required.X-ray examination was performed during operation to determine the anatomical reduction of fracture and fracture gap was <2 mm.There was no need for plaster fixation post-operation.Ambulation occurred at Week 1 and moving ankle joints within 3 weeks.Results Thirty cases were closed and reset and 19 cases were fixed by limited open reduction.The average follow-up period was 38(12-90) months.Final X-ray examination showed that bone healed without unevenness of joint surface.There was no varus or shortening deformity of ankle joint.And external fixator was removed at Weeks 5-8.The outcomes of AOFAS scoring system were excellent (n=39),decent (n=9) and fair (n=1).All children resumed normal physical activities.Conclusion External joint fixation is satisfactory for distal radius fractures in children.It can better restore the surface level of ankle joint,early weight bearing and avoid ankle joint stiffness.It is an excellent option for treating humeral fractures in children.
参考文献/References:
1 Babis GC,Vayanos ED,Papaioannou N,et al.Results of surgical treatment of tibial plafond fractures[J].Clin Orthop Relat Res,1997,341:99-105.
2 Salter RB.Injuries involving the epiphyseal plate[J].Journal of Bone & Joint Surgery American Volume,1963,45(10):1414-1420.
3 Tarkin IS,Clare MP,Marcantonio A,et al.An update on the management of high-energy pilon fractures[J].Injury,2008,39(2):142-154.DOI:10.1016/j.injury.2007.07.024.
4 Korkmaz A,Ciftdemir M,Ozcan M,et al.The analysis of the variables,affecting outcome in surgically treated tibia pilon fractured patients[J].Injury,2013,44(10):1270-1274.DOI:10.1016/j.injury.2013.06.016.
5 Gustilo RB,Anderson JT.Prevention of infection in the treatment of one thousand and twenty five open fracture of long bones:Retrospective and prospective analysis[J].J Bone Joint Surg Am,1976,58(4):453-458.
6 Oh JK,Hwang JH,Sahu D,et al.Complication rate and pitfalls of temporary bridging external fixator in periarticular communited fractures[J].Clin Orthop Surg,2011,3(1):62-68.DOI:10.4055/cios.2011.3.1.62.
7 Olgun ZD,Maestre S.Management of pediatric ankle fractures[J].Curr Rev Musculoskelet Med,2018,11(3):475-484.DOI:10.1007/s12178-018-9510-3.
8 Seel EH,Noble S,Clarke NM,et al.Outcome of distal tibial physeal injuries[J].J Pediatr Orthop B,2011,20(4):242-248.DOI:10.1097/BPB.0b013e3283467202.
9 Spiegel PG,Cooperman DR,Laros GS.Epiphyseal fractures of the distal ends of the tibia and fibula.A retrospective study of two hundred and thirty-seven cases in children[J].J Bone Joint Surg Am,1978,60(8):1046-1050.
10 Kling TF Jr,Bright RW,Hensinger RN.Distal tibial physeal fractures in children that may require open reduction[J].J Bone Joint Surg Am,1984,66(5):647-657.
11 Cass JR,Peterson HA.Salter-Harris type-Ⅳ injuries of the distal tibial epiphyseal growth plate,with emphasis on those involving the medial malleolus[J].J Bone Joint Surg Am,1983,65(8):1059-1070.
12 Parikh SN,Mehlman CT.The community orthopaedic surgeon taking trauma call:pediatric ankle fracture pearls and pitfalls[J].J Orthop Trauma,2017,6:S27-S31.DOI:10.1097/BOT.0000000000001014.
13 焦勤,董良超,王林,等.空心螺钉内固定治疗青少年胫骨远端骨骺骨折的疗效观察[J].中华实用儿科临床杂志,2016,31(23):1809-1812.DOI:10.3760/cma.j.issn.2095-428X.2016.23.013. Jiao Q,Dong LC,Wang L,et al.Clinical observation of cannulated screw fixation for distal tibial epiphysis fracture in adolescents[J].Chin J Appl Clin Pdeiatr,2016,31(23):1809-1812.DOI:10.3760/cma.j.issn.2095-428X.2016.23.013.
14 石青,杨建平,龚仁钰,等.手法复位空心螺钉固定治疗儿童胫骨远端三平面骨折[J].中华骨科杂志,2010,30(9):876-881.DOI:10.3760/cma.j.issn.0253-2352.2010.09.010. Shi Q,Yan JP,Gong RY,et al.Clinical observation of cannulated screw fixation for distal tibial epiphysis fracture in adolescents[J].Chin J Orthop,2010,30(9):876-881.DOI:10.3760/cma.j.issn.0253-2352.2010.09.010.
15 刘伟军,王俊文,焦竞,等.两种不同外固定支架治疗胫骨远端骨折的疗效比较[J].中华创伤骨科杂志,2011,13(6):503-507.DOI:10.3760/cma.j.issn.1671-7600.2011.06.002. Wang WJ,Wang JW,Jiao J,et al.Unilateral versus bilateral external fixator in surgical treatment of distal tibial fracture[J].Chin J orthop Trauma,2011,13(6):503-507.DOI:10.3760/cma.j.issn.1671-7600.2011.06.002.
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备注/Memo
收稿日期:2018-09-25。
通讯作者:宿玉玺,Email:yuxisu@vip.qq.com