Golański Grzegorz, Flont Paweł, Lipczyk Zbigniew, Niedzielski Kryspin Ryszard
Klinika Ortopedii i Traumatologii z Pododdziałem Chirurgii Reki dla Dzieci, Instytut Centrum Zdrowia Matki Polki w Łodzi.
Chir Narzadow Ruchu Ortop Pol. 2010 Sep-Oct;75(5):305-11.
Fracture of the tibial eminence in children is a condition in which there is no widely accepted and approved therapeutic scheme. The greatest divergence of treatment options concerns type II according to Mayers and McKeever classification. Described therapeutic options range from cast immobilisation of the lower extremity without attempt of closed reduction to open reduction with internal fixation. Paper shows the results of treatment of tibial emienence fractures in children treated at our institution. Cohort of patients consists of 21 children at age 7 to 16 years of age (mean 12.2 years). There were three cases of type I, five cases of type II and thirteen cases of type III fracture according to Mayers and McKeever classification. Operatively 16 patients were treated with type II and III fracture, and the rest of them were treated nonoperatively. Open reduction and internal fixation was performed according to modified technique described in 1937 by H. Lee. The results were evaluated by X-ray, clinical examination of stability and range of motion of the affected knee and by subjective clinical outcome with use of modified Lysholm knee scale. All patients treated operatively presented very good and good clinical outcome. Nonoperatively treated patients was a small and no homogenous group. Results of treatment ranged from very good to poor. Worse outcomes were associated with additional injuries to the affected knee (poor result in patient with type II fracture) and qualification for the conservative treatment in patient with type III fracture.
儿童胫骨结节骨折是一种尚无广泛接受和认可治疗方案的病症。治疗方案的最大分歧在于梅耶斯和麦基弗分类法中的II型骨折。所描述的治疗选择范围从不对下肢进行闭合复位的石膏固定到切开复位内固定。本文展示了在我们机构接受治疗的儿童胫骨结节骨折的治疗结果。患者队列由21名7至16岁的儿童组成（平均12.2岁）。根据梅耶斯和麦基弗分类法，有3例I型骨折、5例II型骨折和13例III型骨折。16例II型和III型骨折患者接受了手术治疗，其余患者接受了非手术治疗。切开复位内固定术是根据H. 李于1937年描述的改良技术进行的。通过X线、患侧膝关节稳定性和活动范围的临床检查以及使用改良的Lysholm膝关节评分的主观临床结果对结果进行评估。所有接受手术治疗的患者均呈现出非常好和良好的临床结果。非手术治疗的患者数量较少且不具有同质性。治疗结果从非常好到差不等。较差的结果与患侧膝关节的额外损伤（II型骨折患者结果较差）以及III型骨折患者采用保守治疗有关。
