关节镜下撬拨复位内固定在胫骨远端Salter-HarrisⅢ、Ⅳ型骨骺损伤治疗中的应用  

Application of arthroscopic poking reduction and internal fixation in the treatment of Salter-Harris typesⅢandⅣepiphyseal injuries of the distal tibia

作　　者：杨龙 石荣剑 周吉 孙杰 曹广超 Yang Long;Shi Rongjian;Zhou Ji;Sun Jie;Cao Guangchao(Department of Foot and Ankle Surgery,Xuzhou Renci Hospital,Xuzhou 221000,China)

机构地区：[1]徐州仁慈医院足踝外科,徐州221000

出　　处：《中华解剖与临床杂志》2023年第7期448-453,共6页Chinese Journal of Anatomy and Clinics

基　　金：徐州市重点研发计划(社会发展)(20220621)。

摘　　要：目的探讨关节镜下撬拨复位内固定在治疗胫骨远端Salter-HarrisⅢ、Ⅳ型骨骺损伤中的应用效果。方法病例系列报告。纳入2020年6月—2022年6月徐州仁慈医院采用关节镜下复位骨折克氏针或螺钉固定治疗的9例(9足)胫骨远端Salter-HarrisⅢ、Ⅳ型骨骺损伤患者的临床资料。其中男6例,女3例;年龄8~15(12.1±2.0)岁;右足3例,左足6例。术后定期随访,记录患者术后并发症的情况、骨折愈合时间;采用视觉模拟评分法(VAS)评分、美国足踝外科协会(AOFAS)踝-后足评分评估疼痛和踝关节功能;测量下肢力线及胫骨长度,比较末次随访时患侧与对侧的胫骨全长。结果9例患者均获随访6~21(14.7±4.6)个月,术后患者切口无感染、裂开等并发症,均一期愈合;骨折端均愈合良好,骨折愈合时间10~14(11.9±1.4)周。末次随访时,患者疼痛VAS评分为1(1,2)分,较术前的6(5,6)分改善明显,差异有统计学意义(Z=4.50,P=0.004);AOFAS评分87~93(90.0±1.9)分,踝关节功能均为优;9例患者下肢力线无异常,患侧胫骨全长为29.2(28.1,30.4)cm,健侧胫骨全长为29.4(28.3,30.5)cm,差异无统计学意义(Z=-2.50,P=0.063)。患者均无患肢缩短或内外翻等畸形发生。结论踝关节镜下撬拨复位内固定治疗胫骨远端Salter-HarrisⅢ、Ⅳ型骨骺损伤创伤小,患者恢复快,骨骺愈合良好,短期随访效果满意,是微创治疗胫骨远端Salter-HarrisⅢ、Ⅳ型骨骺损伤的可靠方案。Objective This study aimed to investigate the effect of arthroscopic poking reduction internal fixation in the treatment of distal tibial Salter-Harris typesⅢandⅣepiphyseal injuries.MethodsThis was a case series report that included the clinical data of 9 foot patients with distal tibial Salter-Harris typesⅢandⅣepiphyseal injuries treated with arthroscopic fracture reduction with Kirschner wire or screw fixation at Xuzhou Renci Hospital from June 2020 to June 2022.Among them,6 cases were male and 3 cases were female(aged 8-15[12.1±2.0]years old).The right foot was in 3 cases and the left foot in 6 cases.Regular postoperative follow-up was performed.The postoperative surgical complications and fracture healing time of the patients were recorded.Ankle function was assessed using the visual analog scoring(VAS)score,and the American Association of Foot and Ankle Surgery(AOFAS)ankle-hindfoot score.Full-length lower extremity films were reviewed every 6 months to measure the force line and length of the affected extremity.The lower limb force line and tibia length were measured to observe the sequelae of epiphyseal injury,and the total length of the tibia was compared between the affected side and the contralateral side at the last follow-up.Results All 9 patients were followed up 6-21(14.7±4.6)months.Postoperatively,all patients achieved one-stage healing of the incision without complications,such as infection and wound dehiscence.Furthermore,the fracture ends all healed well,with the bone healing time was 10-14(11.9±1.4)weeks.At the final follow-up,the VAS score of the patients was 1(1,2),which was significantly improved compared with 6(5,6)before surgery;this difference was statistically significant(Z=4.50,P=0.004).The A0FAS score was 87-93(90.0±1.9),and the ankle joint function was excellent.There were no abnormalities in the strength lines of lower limbs in 9 patients,with the length of affected and healthy limbs being 29.2(28.1,30.4)cm and 29.4(28.3,30.5)cm,respectively,with no statistical significanc

关 键 词：胫骨骨折 骨骺损伤 胫骨远端 关节镜手术 

分 类 号：R687.3[医药卫生—骨科学]