对比 1.5cm 以上移位的前上髂嵴撕脱骨折中使用可吸收螺钉的非手术与手术治疗。

Comparison of non-surgical and surgical treatment using absorbable screws in anterior-superior iliac spine avulsion fractures with over 1.5cm displacement.

机构信息

Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, 400014 Chongqing, China.

Clinical Laboratory Department, Maternal and Child Health Care Hospital of Chongqing Yubei District, Chongqing, China.

出版信息

Orthop Traumatol Surg Res. 2020 Nov;106(7):1299-1304. doi: 10.1016/j.otsr.2020.02.014. Epub 2020 May 11.

DOI:10.1016/j.otsr.2020.02.014

PMID:32409270

Abstract

INTRODUCTION

There is some debate over the best treatment for anterior-superior iliac spine (ASIS) avulsion fractures, although non-surgical treatment can achieve the same results as open surgery.

HYPOTHESIS

Absorbable screws can be safely used for ASIS avulsion fractures in children and adolescents.

AIM OF THE STUDY

Here, we compared patients on whom no surgery was performed with those who underwent open surgery and investigated the feasibility of using absorbable screws as a new fixation material for treating ASIS avulsion fractures in children and adolescents.

PATIENTS AND METHODS

We retrospectively analyzed the data of 59 patients diagnosed with ASIS avulsion fractures in our hospital between January 2009 and December 2016. Based on the clinical data, these patients were assigned into group A (non-surgical group) and group B (absorbable screws group). After the inclusion and exclusion criteria were applied, patients' clinical records, including radiographs, were analyzed. All patients were assessed for range of motion (ROM) and by X-ray as they returned to activity. Evaluation of hip function was done by calculating the American Academy of Orthopedic Surgeons (AAOS) lower limb and hip scores.

RESULTS

According to AAOS scores, there were significant differences between the two groups at the first and third months postoperatively (p=0.003), but by the sixth and twelfth months, there was no significant difference (p=0.42). Significant differences were also observed between both groups regarding callus growth on radiographs, time to resume sporting activities, and occurrence of complications such as meralgia paresthetica. All complications resolved by 6 months follow-up.

CONCLUSION

Our study agrees with previous reports, absorbable screws can be safely used for ASIS avulsion fractures with greater than 1.5cm displacement in children and adolescents. In comparison with non-surgical therapy, our results indicate that absorbable screws are associated with shorter recovery time and lesser early complications.

LEVEL OF EVIDENCE

IV, retrospective study with control group.

摘要

引言

对于前上髂嵴（ASIS）撕脱骨折的最佳治疗方法存在一些争议，尽管非手术治疗可以达到与开放手术相同的效果。

假说

可吸收螺钉可安全用于儿童和青少年的 ASIS 撕脱骨折。

研究目的

本研究比较了未行手术治疗的患者与行开放手术的患者，并探讨了可吸收螺钉作为一种新的固定材料治疗儿童和青少年 ASIS 撕脱骨折的可行性。

患者和方法

我们回顾性分析了 2009 年 1 月至 2016 年 12 月期间我院诊断为 ASIS 撕脱骨折的 59 例患者的数据。根据临床资料，将这些患者分为 A 组（非手术组）和 B 组（可吸收螺钉组）。在应用纳入和排除标准后，分析了患者的临床记录，包括影像学资料。所有患者在恢复活动时均通过 X 射线进行活动范围（ROM）和髋关节功能评估。采用美国矫形外科医师学会（AAOS）下肢和髋关节评分评估髋关节功能。

结果

根据 AAOS 评分，术后第 1 个月和第 3 个月两组间存在显著差异（p=0.003），但术后第 6 个月和第 12 个月时，两组间无显著差异（p=0.42）。两组患者在 X 线片上的骨痂生长、恢复运动活动的时间以及出现股外侧皮神经麻痹等并发症方面也存在显著差异。所有并发症在 6 个月随访时均得到解决。