青少年胫骨远端骨折导致不同严重程度骨骺损伤的危险因素分析  

Risk factors for varying severities of epiphyseal injury caused by distal tibial fractures in adolescents

作　　者：冯铜铜 姜鑫 屈继宁[1] 王瑜 杨亚婷 刘帅坤 韩铠阳 贾昊若 颉强 Feng Tongtong;Jiang Xin;Qu Jining;Wang Yu;Yang Yating;Liu Shuaikun;Han Kaiyang;Jia Haoruo;Jie Qiang(Honghui Hospital Affiliated to Xi'an Jiaotong University,Children's Bone Disease Hospital,Xi'an 710054,China;Xi'an Medical College,Xi'an 710068,China)

机构地区：[1]西安交通大学附属红会医院,儿童骨病医院,西安710054 [2]西安医学院,西安710068

出　　处：《中华骨科杂志》2024年第24期1588-1593,共6页Chinese Journal of Orthopaedics

基　　金：陕西省卫生健康科研创新能力提升计划平台建设项目(2024PT-12);陕西省儿童骨骼畸形与损伤疾病临床医学研究中心(2024SF-LCZX-16)。

摘　　要：目的探讨青少年胫骨远端骨折导致不同严重程度骨骺损伤的危险因素。方法回顾性分析2018年1月至2023年12月西安交通大学附属红会医院儿童骨病医院收治的195例胫骨远端骨折致骨骺损伤患儿的临床资料,男132例、女63例,年龄(11.7±2.1)岁(范围5~15)岁,左侧91例、右侧104例。骨骺损伤的Salter-Harris分型:Ⅰ型42例、Ⅱ型90例、Ⅲ型34例、Ⅳ型26例、Ⅴ型3例。损伤原因:运动损伤37例、车祸伤29例、摔伤120例、坠落伤9例。依据致伤机制Dias-Tachdjian分型,旋后内翻型65例、旋后跖屈型59例、旋后外旋型35例、旋前外翻外旋型36例。其中72例患者合并腓骨骨折,56例伴有骨膜嵌顿。比较Salter-Harris各型损伤患儿的年龄、性别、损伤侧位、体质指数、损伤原因、有无腓骨骨折、致伤机制,将差异有统计学意义的指标纳入多分类变量logistic回归分析,确定造成Salter-Harris分型的各型损伤的独立危险因素。结果Ⅰ~Ⅳ型患者的年龄分别为(10.70±2.77)、(12.18±1.70)、(11.32±2.08)、(12.35±1.19)、(11.67±2.08)岁,差异有统计学意义(F=4.794,P=0.001);体质指数分别为(11.90±3.84)、(21.30±4.48)、(21.41±4.08)、(22.42±3.74)、(24.32±4.82)kg/m 2,差异有统计学意义(F=1.914,P=0.009);运动损伤、车祸伤、摔伤、坠落伤的例数分别为6、7、23、6,17、12、59、2,6、5、22、1,7、4、15、0,1、1、1、0例,差异有统计学意义(P=0.032);旋后内翻、旋前外翻外旋、旋后跖屈、旋后外旋的例数分别为21、6、9、6,21、16、37、16,19、6、8、1,4、7、4、11,0、1、1、1例,差异有统计学意义(P=0.001);发生骨膜嵌顿的例数分别为10、36、7、1和2例,差异有统计学意义(χ^(2)=17.156,P=0.002)。骨骺损伤各分型患者的性别、损伤侧别、是否伴有腓骨骨折的差异无统计学意义(P>0.05)。将年龄、体质指数、损伤原因、致伤机制、骨膜嵌顿纳入回归分析,以Salter-HarrisⅠ型作为参照,Objective To explore the risk factors for different severities of epiphyseal injury caused by distal tibial fractures in adolescents.Methods A retrospective analysis was conducted on 195 children with distal tibial fractures accompanied by epiphyseal injuries who were admitted to the Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2018 to December 2023.Among them,there were 132 males and 63 females;the age was 11.7±2.1 years(range,5-15 years).Among them,91 cases were on the left side and 104 cases were on the right side.Salter-Harris classification of epiphyseal injuries:there were 42 cases of type I,90 cases of type Ⅱ,34 cases of type Ⅲ,26 cases of type IV,and 3 cases of type V.Causes of injury:37 cases were sports injuries,29 cases were traffic accident injuries,120 cases were fall injuries,and 9 cases were fall from height injuries.Dias-Tachdjian classification of injury mechanisms:there were 65 cases of supination-adduction type,59 cases of supination-plantar flexion type,35 cases of supination-external rotation type,and 36 cases of pronation-abduction-external rotation type.Among them,72 cases were complicated with fibular fractures,and 56 cases were accompanied by periosteum incarceration.The age,gender,side of injury,body mass index,cause of injury,presence or absence of fibular fracture,and injury mechanism of children with each type of Salter-Harris injury were compared.The indicators with statistically significant differences were included in the multiple logistic regression analysis to determine the independent risk factors for each type of Salter-Harris injury.Results The ages of patients with typeⅠ-Ⅳwere 10.70±2.77,12.18±1.70,11.32±2.08,12.35±1.19,and 11.67±2.08 years old respectively,and the difference was statistically significant(F=4.794,P=0.001).The body mass indexes were 11.90±3.84,21.30±4.48,21.41±4.08,22.42±3.74,and 24.32±4.82 kg/m 2 respectively,and the difference was statistically significant(F=1.914,P=0.009).The numbers of cases of sports injuries/tr

关 键 词：青少年 胫骨骨折 骨骺 危险因素 

分 类 号：R68[医药卫生—骨科学]