Los Angeles Orthopaedic Hospital, Los Angeles, CA 90007, USA.
J Bone Joint Surg Am. 2012 Oct 17;94(20):1853-60. doi: 10.2106/JBJS.J.01728.
Many orthopaedic surgeons treat tibial shaft fractures in children with a period of non-weight-bearing after application of a long leg cast, presumably to prevent fracture angulation and shortening. We hypothesized that allowing children to immediately bear weight as tolerated in a cast with the knee in 10° of flexion would lessen disability, without increasing the risk of unacceptable shortening or angulation.
We divided eighty-one children, between the ages of four and fourteen years, with a low-energy, closed tibial shaft fracture into two groups. One group (forty children) received a long leg cast with the knee flexed 60° and were asked not to bear weight. The second group (forty-one children) received a long leg cast with the knee flexed 10° and were encouraged to bear weight as tolerated. All patients were switched to short leg walking casts at four weeks. We compared time to healing, overall alignment, shortening, and physical disability as determined by the Activities Scale for Kids-Performance (ASK-P) questionnaire.
The mean time to fracture union was 10.8 weeks in both groups (p = 0.47). At the time of healing, mean coronal alignment was within 1.3° in both groups, mean sagittal alignment was within 1°, and mean shortening was <0.5 mm, with no significant differences. The ASK-P scores showed that both groups had overall improvement in physical functioning over time. However, at six weeks, the children who were allowed to bear weight as tolerated had better overall scores (p = 0.03) and better standing skills (p = 0.01) than those who were initially instructed to be non-weight-bearing.
Children with low-energy tibial shaft fractures can be successfully managed by immobilizing the knee in 10° of flexion and encouraging early weight-bearing, without affecting the time to union or increasing the risk of angulation and shortening at the fracture site.
许多骨科医生在应用长腿石膏后让儿童胫骨骨干骨折患者进行一段时间的不负重，大概是为了防止骨折成角和缩短。我们假设让儿童在膝关节屈曲 10°的石膏中尽可能地负重会减轻残疾，而不会增加不可接受的缩短或成角的风险。
我们将 81 名年龄在 4 至 14 岁之间的低能闭合性胫骨骨干骨折患儿分为两组。一组（40 名）接受膝关节屈曲 60°的长腿石膏，并要求不承重。第二组（41 名）接受膝关节屈曲 10°的长腿石膏，并鼓励尽可能承重。所有患者均在 4 周时改为短腿步行石膏。我们比较了愈合时间、整体对线、缩短和身体残疾（由儿童活动量表-表现（ASK-P）问卷确定）。
两组的平均骨折愈合时间均为 10.8 周（p=0.47）。在愈合时，两组的冠状面平均对线均在 1.3°以内，矢状面平均对线均在 1°以内，平均缩短均<0.5mm，无显著差异。ASK-P 评分显示，两组儿童的身体功能随着时间的推移都有总体改善。然而，在 6 周时，允许患者尽可能承重的儿童的整体评分（p=0.03）和站立技能（p=0.01）更好。
儿童低能胫骨骨干骨折可通过将膝关节固定在 10°的屈曲位并鼓励早期负重来成功治疗，不会影响愈合时间，也不会增加骨折部位成角和缩短的风险。
