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  

Clinical observation of cannulated screw fixation for distal tibial epiphysis fracture in adolescents

作　　者：焦勤[1] 董良超[1] 王林[1] 王隼[1] 应灏[1] 

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院骨科,200062

出　　处：《中华实用儿科临床杂志》2016年第23期1809-1812,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市科学技术委员会“科技创新行动计划”科普项目指南（16DZ2346500）

摘　　要：目的探讨空心螺钉内固定治疗青少年胫骨远端骨骺骨折的临床疗效。方法2005年2月至2014年9月上海市儿童医院收治的胫骨远端骨骺骨折39例，男24例，女15例；年龄10.5～16.2岁，平均13.1岁；右踝29例，左踝10例。术前经X线片或CT检查确诊。全部病例均为闭合性骨折，经手法复位治疗失败（X线片或CT骨折间隙〉2 mm）后行手术治疗。手术在＂C＂型臂X线机监视下进行，行踝关节轴向牵引，根据骨折类型内旋或外旋足，达到解剖复位后行经皮空心螺钉固定，如不能达到解剖复位则行切开复位空心螺钉固定。经皮空心螺钉固定30例，切开复位空心螺钉固定9例。术后行X线或CT检查，确定骨折解剖复位，骺板及关节面骨折间隙〈2 mm。术后短腿石膏固定4～6周。以美国足踝外科协会（AOFAS）评估标准评价踝关节功能及愈合情况。结果全部病例随访5～91个月，平均35个月。X线片检查所有病例均骨性愈合，未发现关节面不平整现象，无踝关节内外翻和短缩畸形。AOFAS评分系统评判结果为优27例，良10例，一般2例。患儿均能参加正常的体育活动。结论CT多维重建是获得准确诊断，选择合理入路的前提；对于胫骨远端骨骺骨折手法复位失败者，采用空心螺钉固定方法手术操作简单，疗效满意。ObjectiveTo explore the clinical curative effect of hollow screw internal fixation for the treatment of distal epiphyseal teenagers tibial fracture.MethodsThirty-nine cases of epiphyseal fractures of the distal tibia were treated in Shanghai Children′s Hospital between February 2005 and September 2014.This study included 24 boys and 15 girls with the average age of 13.1 years （ranged 10.5 to 16.2 years old）. Preoperative diagnosis was confirmed by the X-ray films or CT examination.All the cases were closed fractures and manipulative reduction all failed.Surgical reduction was performed when plain radiographs showed the fracture gap of epiphysis board and articular surface were greater than 2 mm or after closed reduction.Under C-arm X-ray machine, ankle axial traction was performed initially.Anatomical reduction underwent according to the bone fracture type.The fractures were fixed with cannulated screws by percutaneous or open approach.Postoperative X-ray or CT confirmed anatomical reduction at articular surface and growth plate.All patients had been immobilized with short-leg cast for 4-6 weeks.The ankle joint function and growth were evaluated by means of American Orthopaedic Foot and Ankle Society（AOFAS） Ankle Hindfoot Scale.ResultsAll patients were followed up for 5 to 91 months with an average duration of 35 months.X-ray films showed that all fractures were bone healing.No uneven articular surface was found and there was no extremity rotation and shorte-ning deformity.Results were evaluated by AOFAS scoring system： excellent in 27 cases, good in 10 cases, and general in 2 cases.All patients were able to participate in the normal physical activities.ConclusionsCT with multiplanar reconstruction is a premise to make an accurate diagnosis and to choose a reasonable approach.For failed closed reduction for adolescent distal tibial epiphyseal fractures, the cannulated screws are simple and may have a satisfactory effect.

关 键 词：胫骨骨折 骨骺 青少年 

分 类 号：R726.8[医药卫生—儿科]