空心螺钉与克氏针固定治疗儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折的疗效比较  

Comparison of cannulated screws and Kirschner wires in the treatment of pediatric medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ

作　　者：潘源城 卢凤珊[2] 陈添来 马洪[2] 郭跃明[2] 李伟强[2] 陈顺有 Pan Yuancheng;Lu Fengshan;Chen Tianlai;Ma Hong;Guo Yueming;Li Weiqiang;Chen Shunyou(Department of Pediatric Orthopaedics,Fuzhou Second General Hospital,Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma,Fuzhou 350007,China;Department of Pediatric Orthopaedics,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]福州市第二总医院小儿骨科,福建省创伤骨科急救与康复临床医学研究中心,福州350007 [2]佛山市中医院小儿骨科,佛山528000

出　　处：《中华创伤骨科杂志》2024年第5期398-403,共6页Chinese Journal of Orthopaedic Trauma

基　　金：福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014);福州市临床重点专科建设项目(20220104)。

摘　　要：目的比较空心螺钉与克氏针固定治疗儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折的疗效。方法回顾性分析福州市第二总医院小儿骨科和佛山市中医院小儿骨科自2016年6月至2022年6月分别收治的48、16例儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折患者资料。男32例,女32例;年龄12(10,14)岁;左侧31例,右侧33例;骨折Salter-Harris分型:Ⅲ型45例,Ⅳ型19例。根据内固定方式不同分为2组:空心螺钉组44例(采用空心螺钉固定),克氏针组20例(采用克氏针固定)。末次随访时摄踝关节正、侧位X线片对两组患儿进行影像学评估,并根据踝关节活动度和美国足踝外科协会(AOFAS)踝-后足评分评定患肢功能恢复情况,同时记录相关并发症。结果除侧别外,两组患儿术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患儿术后获(37.3±21.5)个月随访,骨折均获骨性愈合。末次随访时空心螺钉组与克氏针组患儿患侧胫骨远端外侧角分别为89.0°(89.0°,90.0°)、89.0°(89.0°,90.0°),踝关节活动度分别为73.5°(67.8°,76.0°)、70.0°(70.0°,75.0°),AOFAS踝-后足评分优良率分别为97.7%(43/44)、95.0%(19/20),以上项目两组间比较差异均无统计学意义(P>0.05)。空心螺钉组与克氏针组患儿术后骨骺早闭发生率分别为36.4%(16/44)和65.0%(13/20),差异有统计学意义(P=0.033)。结论空心螺钉与克氏针固定治疗儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折均可获得良好的功能结果。然而,空心螺钉固定在减少骨骺早闭的风险方面更有优势。Objective To compare the therapeutic effects of cannulated screws and Kirschner wires in the treatment of medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ in children.Methods A retrospective study was conducted to analyze the data of 48 and 16 children who had been treated respectively at Department of Pediatric Orthopaedics,Fuzhou Second General Hospital,and Department of Pediatric Orthopaedics,Foshan Hospital of Traditional Chinese Medicine for medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ from June 2016 to June 2022.There were 32 males and 32 females with an age of 12(10,14)years;31 left and 33 right sides were affected.By the Salter-Harris classification:type Ⅲ in 45 cases,and type Ⅳ in 19 cases.The patients were divided into 2 groups according to their internal fixation methods.Group A(44 cases)was subjected to internal fixation with cannulated screws and group B(20 cases)to internal fixation with Kirschner wires.At the last follow-up,anteroposterior and lateral X-ray films of their ankle joints were taken for imaging evaluation.Functional recovery of the affected limbs was evaluated based on the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scoring,and related complications were recorded.Results The 2 groups were comparable because there were no significant differences in their preoperative general data except laterality(P>0.05).All the patients were followed up for(37.3±21.5)months and achieved bony union.At the last follow-up,for groups A and B respectively,the distal lateral angle of the tibia was 89.0°(89.0°,90.0°)and 89.0°(89.0°,90.0°),the range of ankle motion was 73.5°(67.8°,76.0°)and 70.0°(70.0°,75.0°),and the good and excellent rate by the AOFAS ankle-hindfoot scoring was 97.7%(43/44)and 95.0%(19/20),showing no significant difference between the 2 groups(P>0.05).There was a significant difference between the 2 groups in the incidence of premature physeal closure[36.4%(16/44)versus 65.0%(13/20)](P=0.033).Conclusions In the treatment of

关 键 词：儿童 骨折固定术 内 踝关节 Salter-Harris分型 

分 类 号：R726.8[医药卫生—儿科]