超声引导克氏针挑拨技术治疗儿童青少年Salter-Harris Ⅰ、Ⅱ型骨膜卡压胫骨远端骨骺骨折短期疗效  

Short-term effectiveness of ultrasound-guided Kirschner wire provocation technique in treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents

作　　者：马海龙 周志林[1] 张思成[1] 刘方[1] 华中托 孙锡玮 贾国强 孙军[1] MA Hailong;ZHOU Zhilin;ZHANG Sicheng;LIU Fang;HUA Zhongtuo;SUN Xiwei;JIA Guoqiang;SUN Jun(Department of Orthopedics,Anhui Medical University Children’s Medical Center,Anhui Provincial Children’s Hospital,Hefei Anhui,230051,P.R.China)

机构地区：[1]安徽医科大学儿童医学中心、安徽省儿童医院骨科,合肥230051

出　　处：《中国修复重建外科杂志》2023年第12期1477-1481,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(U19A2057);安徽省卫生健康科研项目(AHWJ2022b008);安徽医科大学校基金青年科学基金项目(2022xkj112);安徽省儿童医院科研项目(21etyy002)。

摘　　要：目的探讨超声引导克氏针挑拨技术闭合复位经皮克氏针内固定治疗儿童青少年Salter-Harris Ⅰ、Ⅱ型骨膜卡压胫骨远端骨骺骨折短期疗效。方法2019年5月—2022年5月收治41例Salter-Harris Ⅰ、Ⅱ型胫骨远端骨骺骨折儿童青少年患者,术前行MRI检查均存在骨膜卡压,术中经超声检查证实有38例(92.7%)发生骨膜卡压,最终纳入研究。男24例,女14例;年龄6.8~15.7岁,平均10.7岁。Salter-Harris Ⅰ型20例、Ⅱ型18例。受伤至手术时间22~76 h,平均28.4 h。术前影像学检查示力线对合情况为优4例、良20例、差14例。行超声引导克氏针挑拨技术闭合复位经皮克氏针内固定治疗。记录患者手术时间、术中透视次数、骨折愈合时间及并发症发生情况。术后随访时摄患侧踝关节正侧位X线片观察骨折复位及愈合情况,并测量外侧胫骨远端机械角(mechanical lateral distal tibia angle,mLDTA)和前侧胫骨远端解剖角(anatomic anterior distal tibia angle,aADTA);摄双下肢全长正位X线片对比两侧肢体力线以评价患肢力线对合情况;采用患侧踝关节背伸-跖屈、内翻-外翻活动度(range of motion,ROM),疼痛视觉模拟评分(VAS)及美国矫形足踝协会(AOFAS)踝-后足评分评价踝关节功能。结果手术时间17~52 min,平均22.6 min;术中透视次数3~11次,平均4.2次。术中及术后2 d X线片检查均显示骨折获解剖复位。患者均获随访,随访时间10~24个月,平均16.4个月。所有患者骨折均愈合,愈合时间6.1~7.2周,平均6.3周;随访期间未出现骨折再移位,术后6个月恢复伤前运动水平。术后4周2例发生针尾激惹,经对症处理后康复;随访期间均未发生切口深度感染、骨不连、延迟愈合、畸形愈合等严重并发症。末次随访时,患者力线对合情况均达优,与术前比较差异有统计学意义(Z=-7.471,P<0.001)。术后3个月及末次随访时VAS评分、AOFAS踝-后足评分、背伸-跖屈ROM、内翻-外翻ROM及mLObjective To investigate the short-term effectiveness of ultrasound-guided closed reduction by Kirschner wire provocation technique in the treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents.Methods Between May 2019 and May 2022,41 patients with Salter Harris types Ⅰ and Ⅱ distal tibial epiphyseal fractures were admitted,all of whom had periosteal entrapment on preoperative MRI,and 38 cases(92.7%)were confirmed to have periosteal entrapment by intraoperative ultrasound.There were 24 males and 14 females,the age ranged from 6.8 to 15.7 years,with an average of 10.7 years;and there were 20 cases of Salter Harris type Ⅰ and 18 cases of type Ⅱ.The time from injury to operation was 22-76 hours,with an average of 28.4 hours.The preoperative imaging examination showed excellent alignment in 4 cases,good in 20 cases,and poor in 14 cases.The ultrasound guided Kirschner wire provocation technique for closed reduction and percutaneous Kirschner wire internal fixation were performed.The operation time,intraoperative fluoroscopy frequency,fracture healing time,and complications were recorded.Anteroposterior and lateral X-ray films of the affected ankle joint were taken before operation,at 3 months after operation,and at last follow-up to observe the healing of the fracture,and anteroposterior Xray films of the whole length of both lower limbs were taken to evaluate the alignment of the force lines of the affected limbs.The range of motion(ROM),visual analogue scale(VAS)score,and American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score were used to evaluate ankle function.The mechanical lateral distal tibia angle(mLDTA)and the anatomic anterior distal tibia angle(aADTA)were measured.Results The operation time ranged from 17 to 52 minutes,with an average of 22.6 minutes,and the intraoperative fluoroscopy frequency ranged from 3 to 11 times,with an average of 4.2 times.X-ray examination during operation and at 2 days after oper

关 键 词：胫骨远端骨折 骨骺骨折 骨膜卡压 超声引导 儿童 青少年 

分 类 号：R726.8[医药卫生—儿科]