组合式外固定架与克氏针固定儿童胫骨远侧干骺端骨折  

Combined external fixator versus Kirschner wire for the treatment of distal tibial metaphyseal fracture in children

作　　者：张天久[1] 俞松[1] 杨小红[1] 吕欣[1] 徐艳朋[1] 罗宇[1] 

机构地区：[1]遵义医学院附属医院小儿骨科,贵州遵义563003

出　　处：《中国矫形外科杂志》2017年第20期1830-1834,共5页Orthopedic Journal of China

摘　　要：[目的]比较组合式外固定架与克氏针固定治疗儿童胫骨远侧干骺端骨折的临床效果。[方法]回顾性分析本科2010年1月~2016年6月收治的52例儿童胫骨远侧干骺端骨折患者的临床资料,男28例,女24例,年龄3.5~14岁,平均8.5岁,受伤至手术时间1~11 d,平均3.6 d;骨折复位后采用组合式外固定架固定20例,克氏针固定32例,两组在性别、年龄、受伤至手术时间上比较差异无统计学意义(P>0.05),对两组患儿的骨折闭合复位成功率、手术时间、骨折愈合时间、术后并发症以及术后3、6、12个月踝关节评分进行比较,结果进行统计学分析。[结果]所有患儿均获随访,随访时间9~42个月,平均23.2个月。两组患儿的骨折愈合时间、术后并发症和术后6、12个月踝关节评分比较差异无统计学意义(P>0.05);在骨折闭合复位成功率、手术时间和术后3个月踝关节评分比较,组合式外固定架组明显优于克氏针组,差异有统计学意义(P<0.05)。[结论]儿童胫骨远侧干骺端骨折,特别是邻近骺板处的骨折在手术时可选用的固定方法有限,采用组合式外固定架和克氏针固定治疗均可获得满意的效果,但组合式外固定架可提高骨折闭合复位成功率,节约手术时间,减少对胫骨远侧骺板的损伤,利于早期踝关节功能锻炼。[Objective] To compare the clinical outcomes of combined external fixator and Kirschner wire for the treat- ment of distal tibial metaphyseal fracture in children. [Methods] From January 2010 to June 2016, 52 children with distal tibial metaphyseal fractures received surgical treatment, including 28 boys and 24 girls with a mean age of 8.5 years （range, 3.5 -14 years）. The time elapsed from injury to operation was 3.6 days （range, 1 -11 days）. According to the fixation methods, patients were divided into the combined external fixation group （n=20 cases） and the Kirschner wire fixation group （n=32 cases） after fractures reduction. There was no significant difference in gender, age, time from injury to operation between the two groups （P〉0.05）. The success rate of closed reduction of fracture, operation time, fracture healing time, postoperative complications, as well as the Kofoed ankle score were compared between the two groups. [Results] All the children were followed up for 9-42 months, with an average of 23.2 months. No significant difference was noted in the fracture healing time, postoperative complications and ankle score at 6, 12 months after operation between the two groups （P〉0.05）. However, the combined external fixation group was significantly superior to the Kirschner wire group in the success rate of closed reduction of fracture, operation time, and Kofoed ankle score at 3 months after operation （P〈0.05）. [Conclusion] There are only limited number of fixation methods for the distal tibial metaphyseal fracture in children, especially adjacent to the epiphyseal plate, Both combined external fixator and the Kirschner wire can obtain satisfactory clinical outcomes, however, the combined external fixator can improve fracture reduction, save the operation time, reduce risk of the injury of distal tibial epiphyseal plate, as well as facilitate the early functional exercises of ankle joint.

关 键 词：胫骨骨折 固定术 外固定架 克氏针 儿童 

分 类 号：R726.8[医药卫生—儿科]