开放性胫骨骨折。儿童是“小大人”吗？
Open tibial fractures. Are children small adults?
作者信息
Gougoulias N E, Khanna A, Maffulin N
机构信息
University Hospital of North Staffordshire, Stoke on Trent, UK.
出版信息
Hippokratia. 2009 Jul;13(3):147-53.
Open tibial fractures in adults have been extensively studied. In children, however, only a small number of case series provide data on management and outcome of these injuries. It is not clear whether open tibial fractures in children 'behave' in a similar fashion to those in adults, and clear guidelines regarding their management do not exist. Primary wound closure after irrigation does not increase infection rates in low grade open tibial fractures. Cast is an effective method for fracture stabilization in stable fractures. External fixation is usually used in patients with significant soft tissue injury, and elastic intramedullary nailing is an alternative. Age over 10 years and open fracture grade III appear to be significant prognostic factors. Complication rates are not unremarkable and long-term studies are required to investigate their consequences. Children over 10 years should probably be managed as adults. Further research is needed to evaluate the effectiveness of different fracture management methods.
成人开放性胫骨骨折已得到广泛研究。然而，关于儿童开放性胫骨骨折，仅有少数病例系列提供了有关这些损伤的治疗及预后的数据。目前尚不清楚儿童开放性胫骨骨折的表现是否与成人相似，且不存在关于其治疗的明确指南。冲洗后一期伤口闭合并不会增加低级别开放性胫骨骨折的感染率。对于稳定骨折，石膏固定是一种有效的骨折稳定方法。外固定通常用于软组织损伤严重的患者，弹性髓内钉固定是一种替代方法。10岁以上及Ⅲ级开放性骨折似乎是重要的预后因素。并发症发生率并非微不足道，需要长期研究来调查其后果。10岁以上儿童或许应按成人进行治疗。需要进一步研究以评估不同骨折治疗方法的有效性。
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