Marti R, Besselaar P P, Raaymakers E
Orthopädisch-Traumatologische Universitätsklinik AMC, Amsterdam.
Orthopade. 1991 Nov;20(6):367-73.
If the correct treatment is applied, growth disturbances following epiphyseal fractures of the distal tibia are rare. Even if the prognosis is good after the correct treatment of epiphyseal fractures of the distal tibia, the parents and child may have to be informed about growth disturbances. Most frequent is a varus deformity after asymmetric closure of the medial growth plate. If at least 2 years of growth can be expected, a callus resection according to Langenskjöld is indicated. If this procedure fails, the ideal timing for a correction is the end of the growth. Imminent contractures can be an indication for early correction even if a recurrent deformity can be expected. An open-wedge osteotomy permits all three procedures to be carried out: callus resection, axis correction and leg-length correction. If an incongruence of the joint is present, the closed wedge technique using an external fixator is indicated; correction of the leg length can be postponed. Joint incongruence reacts well to axis alignment. The pre-arthrotic joint can remain free of symptoms for years. We never encountered epiphyseal fractures of the distal fibula, but we did see one case of deformity of the ankle joint as a result of closure of the proximal fibular growth plate.
如果采用正确的治疗方法，胫骨远端骨骺骨折后出现生长紊乱的情况很少见。即使胫骨远端骨骺骨折经正确治疗后预后良好，也可能需要告知患儿家长和患儿有关生长紊乱的情况。最常见的是内侧生长板不对称闭合后出现内翻畸形。如果预计至少还有2年的生长时间，可根据朗根斯约尔德方法进行骨痂切除术。如果该手术失败，理想的矫正时机是生长结束时。即使预计会出现复发畸形，即将出现的挛缩也可能是早期矫正的指征。开放性楔形截骨术可以进行所有三种手术操作：骨痂切除、轴线矫正和肢体长度矫正。如果存在关节不匹配的情况，则应采用使用外固定器的闭合楔形技术；肢体长度的矫正可以推迟。关节不匹配对轴线对齐反应良好。关节软骨前期可以多年无症状。我们从未遇到过腓骨远端骨骺骨折，但确实见过一例因腓骨近端生长板闭合导致的踝关节畸形病例。
