跨关节外固定架治疗儿童胫骨远端骨折疗效观察  

Clinical efficacy of distal tibial fractures in children with external fixation with joint

作　　者：蔡文全[1] 宿玉玺[1] 覃佳强[1] 南国新[1] 王忠良[1] 何波[1] 陈凯[1] 顾凯[1] 严格[1] 梁珣[1] Cai Wenquan;Su Yuxi;Qin Jiaqiang;Nan Guoxin;Wang Zhongliang;He Bo;Chen Kai;Gu Kai;Yan Ge;Liang Xun(Orthopedic DepartmentⅡ,Children's Hospital of Chongqing Medical University.Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation base of Child development and Critical Disorders,Children's Hospital of Chongqing Medical University,Chongqing,P.R China.400014,China)

机构地区：[1]重庆医科大学附属儿童医院骨二科、儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,国家儿童健康与疾病临床研究中心,重庆市400014

出　　处：《临床小儿外科杂志》2021年第7期677-680,共4页Journal of Clinical Pediatric Surgery

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。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.

关 键 词：胫骨骨折 骨折固定术 治疗结果 儿童 

分 类 号：R726.834.23[医药卫生—儿科] R726.8[医药卫生—临床医学]