儿童浮膝损伤的治疗  

Treatment of floating knee injuries in children

作　　者：于铁强[1] 左玉明[1] 王月光[1] 易凡[1] 张磊[1] 廉小婧 李飞[1] 王晶[1] 赵菁[1] 

机构地区：[1]唐山市第二医院,河北063000

出　　处：《中国骨与关节杂志》2017年第9期709-712,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨儿童浮膝损伤的治疗方法及疗效。方法回顾性分析2008年1月至2014年6月入院的19例浮膝损伤的患儿,其中男12例,女7例;年龄1岁4个月至15岁,平均7岁10个月。左侧8例,右侧10例,双侧1例。致伤原因:交通事故16例;机器绞伤1例;乘坐自行车摔伤1例,跌倒1例。改良Bohn and Durbin分型:Ⅰ型10例(11侧),Ⅱ型6例,Ⅲa型3例。单独胫骨开放骨折4例,股骨、胫骨同时开放骨折2例。合并失血性休克3例,合并颅脑损伤3例,腹部闭合性损伤1例,其它部位骨折10例,合并腓总神经损伤1例,血管损伤1例,骨筋膜室综合征1例,合并皮肤剥脱伤2例。2例年龄<3岁患儿保守治疗,其它均采用手术治疗。结果随访12~48个月,平均18个月。伤口乙级愈合1例,其余均甲级愈合。骨折均达骨性愈合。腓总神经损伤于8周内完全恢复。下肢膝外翻畸形2例,均发生在胫骨近端骨折患儿。双下肢明显不等长(>2 cm)1例。根据Yue等评价标准进行评价:优15例,良1例,可2例,差1例。结论 3岁以下患儿牵引治疗效果良好。手术是治疗3岁以上患儿浮膝损伤的有效方法,根据损伤的"个性"对浮膝损伤制订不同的治疗方案,可有效地减少并发症。Objective To investigate the treatment and clinical outcomes of floating knee injuries in children. Methods A total of 19 cases of floating knee injuries were analyzed from January 2008 to June 2014. There were 12 boys and 7 girls with an average age of 7.8 years （ range： ! year and 4 months to 15 years ）. Left side： 8 cases; right side： 10 cases; the both： 1 case. Causes of injury： traffic accident 16 cases, machine twist 1 case, bicycle falling 1 case, falling 1 case. According to modified Bohn and Durbin classification： type Ⅰ 10 cases （ 11 knees ）, type Ⅱ 6 cases, type Ⅲa 3 cases. Open tibial fracture： 4 cases; open fracture of the femur and tibia： 2 cases. Three cases associated with hemorrhagic shock, 3 cases with craniocerebral injury, 1 case with blunt abdominal trauma, 10 cases with other fractures, 1 case with common peroneal nerve injury, 1 case with vascular injury, 1 case with osteofascial compartment syndrome, 2 cases with skin avulsion injury. Two cases younger than 3 years old received conservative treatment, while others received surgery. Results All patients were followed up for 12 - 48 months with an average of 18 months. All incisions healed by the first intention except for 1 case of the second healing. Fractures were healed. Peroneal nerve injury recovered completely within 8 weeks. Lower limb valgus deformity occurred in 2 cases with proximal tibial metaphyseal fractures. Unequal length of the lower limbs occurred in 1 case （ 〉 2 cm ）. According to the evaluation criteria of Yue： 15 cases were excellent, 1 good, 2 fair, 1 poor. Conclusions Traction treatment effects are good in children 〈 3 years old. Surgery is an effective method for the treatment of floating knee injury in children 〉 3 years old. Individualized treatment plan can effectively reduce complications.

关 键 词：创伤和损伤 膝关节 治疗 骨折固定术 儿童 

分 类 号：R726.8[医药卫生—儿科]