Jones B G, Duncan R D D
The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, UK.
Injury. 2003 Oct;34(10):776-80. doi: 10.1016/s0020-1383(03)00031-7.
To evaluate the results of treatment in children with open tibial fractures.
Retrospective review.
Eighty three children under 13 years of age treated for an open tibial fracture between 1989 and 1999.
Patient demographics, mechanism of injury, fracture classification, treatment method, clinical outcome and complications.
Eighty one percent of children had an open tibial fracture as their only injury. According to the level of contamination, soft tissue injury and size of wound 46% were Gustilo grade I injuries, 30% grade II, and 22% (18) grade III (6 IIIa, 5 IIIb, 3 IIIc and 4 not otherwise specified). Sixteen fractures (19%) were treated using an external fixator and 65 (78%) using a cast. The average time to union was 15.5 weeks (range 9-31 weeks) for those treated with a frame and 10.4 weeks (range 5-40 weeks) for those treated with a cast. No deep infections, one delayed union and one non-union were recorded.
Ninety four percent of these injuries were a result of a motor vehicle accident and involved a significant trauma-related energy transfer. Despite this the associated morbidity was low lending support to the literature, which suggests that open fractures of the tibia in younger children heal more predictably and with less complications than those occurring in adolescents or adults.
评估儿童开放性胫骨骨折的治疗结果。
回顾性研究。
1989年至1999年间接受开放性胫骨骨折治疗的83名13岁以下儿童。
患者人口统计学资料、损伤机制、骨折分类、治疗方法、临床结果及并发症。
81%的儿童仅存在开放性胫骨骨折这一损伤。根据污染程度、软组织损伤及伤口大小，46%为 Gustilo I 级损伤，30%为II级，22%（18例）为III级（6例IIIa型、5例IIIb型、3例IIIc型及4例未另作说明）。16例骨折（19%）采用外固定器治疗，65例（78%）采用石膏固定。采用外固定器治疗者骨折平均愈合时间为15.5周（9 - 31周），采用石膏固定者为10.4周（5 - 40周）。未记录到深部感染，有1例延迟愈合和1例骨不连。
这些损伤中94%是机动车事故所致，涉及显著的与创伤相关的能量转移。尽管如此，相关发病率较低，这与文献报道相符，表明年幼儿童的胫骨开放性骨折比青少年或成人的骨折愈合更具可预测性且并发症更少。
