Leary Jeffrey T, Handling Matthew, Talerico Marcus, Yong Lin, Bowe J Andrew
Department of Orthopedic Surgery, UMDNJ-Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
J Pediatr Orthop. 2009 Jun;29(4):356-61. doi: 10.1097/BPO.0b013e3181a6bfe8.
A retrospective review of 124 patients was undertaken to determine the incidence of physeal growth arrest (premature physeal closure [PPC]) after physeal fractures of the distal end of the tibia in children. We also sought to identify clinical predictors of PPC.
We defined PPC as radiographic evidence of physeal closure as compared to the uninjured side in this patient population. We reviewed the charts of 124 pediatric patients with distal tibia physeal fractures. All patients were followed up until symmetric growth was noted (by Harris growth lines) for a minimum of 1 year or until physiologic closure of the growth plates had been documented radiographically. We calculated the overall incidence of PPC and the incidence by fracture type. Cox multivariate regression analysis was also performed for a number of clinical variables.
The mean follow-up was 57 weeks. Fifteen fractures (12.1%) were complicated by PPC. In our study, 67% of the PPC observed occurred in Salter-Harris II fractures, followed by 13% in Salter-Harris III, 13% in Salter Harris IV, and 7% in triplane fractures. We did not observe any physeal arrest in the Salter-Harris I or Tillaux fractures. Using a Cox multivariate regression analysis, we were able to demonstrate statistically significant correlations between mechanism of injury and PPC and between the amount of initial fracture displacement and the rate of PPC. There was a strong relationship between mechanism of injury and PPC. There were trends seen about residual displacement after reduction and the number of attempted reductions and the rate of PPC, but these correlations were not statistically significant. For each millimeter of initial displacement, there was a relative risk of 1.15 (P < 0.01).
Recent articles have shown a much higher rate of PPC after distal tibia physeal fracture than what was observed in our cohort. The amount of initial fracture displacement and the mechanism of injury have a statistically significant predictive value in determining the likelihood of PPC development after distal tibia physeal fracture. Trends were seen regarding residual displacement and the number of fracture reductions but were not statistically significant in predicting the occurrence of a PPC.
Level III: Retrospective Review.
对124例患儿进行回顾性研究，以确定儿童胫骨远端骨骺骨折后骨骺生长停滞（过早骨骺闭合[PPC]）的发生率。我们还试图确定PPC的临床预测因素。
在本患者群体中，我们将PPC定义为与未受伤侧相比骨骺闭合的影像学证据。我们回顾了124例小儿胫骨远端骨骺骨折患者的病历。所有患者均随访至出现对称生长（通过哈里斯生长线）至少1年，或直至影像学记录到生长板生理性闭合。我们计算了PPC的总体发生率以及按骨折类型划分的发生率。还对一些临床变量进行了Cox多因素回归分析。
平均随访时间为57周。15例骨折（12.1%）并发PPC。在我们的研究中，观察到的PPC中67%发生在Salter-Harris II型骨折，其次是Salter-Harris III型骨折占13%，Salter-Harris IV型骨折占13%，三平面骨折占7%。我们在Salter-Harris I型或Tillaux骨折中未观察到任何骨骺停滞。使用Cox多因素回归分析，我们能够证明损伤机制与PPC之间以及初始骨折移位量与PPC发生率之间存在统计学上的显著相关性。损伤机制与PPC之间存在密切关系。复位后残余移位、尝试复位次数与PPC发生率之间存在一定趋势，但这些相关性无统计学意义。初始移位每增加1毫米，相对风险为1.15（P<0.01）。
近期文章显示胫骨远端骨骺骨折后PPC的发生率远高于我们队列中的观察结果。初始骨折移位量和损伤机制在确定胫骨远端骨骺骨折后发生PPC的可能性方面具有统计学上的显著预测价值。在残余移位和骨折复位次数方面存在一定趋势，但在预测PPC的发生方面无统计学意义。
III级：回顾性研究。
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