切开复位内固定治疗儿童胫骨远端 Salter-Harris Ⅱ型骨折：65 例回顾性研究。

Open reduction and internal fixation for displaced Salter-Harris type II fractures of the distal tibia: a retrospective study of sixty-five cases in children.

机构信息

Children's Hospital of Soochow University, No.92 Zhongnan Street, Suzhou Industiral Park, Suzhou, Jiangsu province, China.

出版信息

J Orthop Surg Res. 2021 Mar 27;16(1):224. doi: 10.1186/s13018-021-02359-9.

DOI:10.1186/s13018-021-02359-9

PMID:33773575

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8004420/

Abstract

BACKGROUND

The treatment for displaced Salter-Harris II (S-H II) distal tibia fractures remains controversial. The purpose of this study was to review S-H II distal tibia fractures and evaluate the rate of premature physeal closure (PPC) treated by open reduction and internal fixation (ORIF).

METHODS

We reviewed the charts and radiographs of S-H II fractures of the distal tibia with displacement > 3 mm between 2012 and 2019 treated by ORIF. Patients were followed up for a minimum of 6 months. CT scans of injured side or contralateral ankle radiograph were obtained if there was any evidence of PPC. Any angular deformity or shortening of the involved leg was documented. Multivariable logistic regression was performed to identify risk factors for the occurrence of PPC.

RESULTS

A total of 65 patients with a mean age of 11.8 years were included in this study. The mean initial displacement was 8.0 mm. All patients but one were treated within 7 days after injury and the mean interval was 3.7 days. Supination-external rotation injuries occurred in 50 patients, pronation-eversion external rotation in 13, and supination-plantar flexion in two. The residual gap was less than 1 mm in all patients following ORIF and all fractures healed within 4-6 weeks. Superficial skin infection developed in one patient. Ten patients complained of the cosmetic scar. The rate of PPC was 29.2% and two patients with PPC developed a varus deformity of the ankle. Patients with associated fibular fracture had 7 times greater odds of developing PPC. Age, gender, injured side, mechanism of injury, amount of initial displacement, interval from injury to surgery, or energy of injury did not significantly affect the rate of PPC.

CONCLUSIONS

ORIF was an effective choice of treatment for S-H II distal tibia fractures with displacement > 3 mm to obtain a satisfactory reduction. PPC is a common complication following ORIF. The presence of concomitant fibula fracture was associated with PPC.

摘要

背景

对于移位的 Salter-Harris II（S-H II）胫骨远端骨折的治疗仍存在争议。本研究的目的是回顾 S-H II 胫骨远端骨折，并评估切开复位内固定（ORIF）治疗的早期骺板闭合（PPC）的发生率。

方法

我们回顾了 2012 年至 2019 年期间接受 ORIF 治疗的伴有> 3mm 移位的 S-H II 胫骨远端骨折患者的病历和 X 线片。患者的随访时间至少为 6 个月。如果有 PPC 的任何证据，将获得受伤侧或对侧踝关节 X 线片的 CT 扫描。记录任何角度畸形或受累腿的缩短。多变量逻辑回归用于确定 PPC 发生的危险因素。

结果

本研究共纳入 65 例患者，平均年龄为 11.8 岁。平均初始移位为 8.0mm。所有患者均在受伤后 7 天内接受治疗，平均间隔为 3.7 天。50 例患者为旋后外旋损伤，13 例为旋前外旋损伤，2 例为旋前跖屈损伤。ORIF 后所有患者的残余间隙均小于 1mm，所有骨折均在 4-6 周内愈合。1 例患者发生浅表皮肤感染。10 例患者抱怨美容性瘢痕。PPC 的发生率为 29.2%，2 例 PPC 患者出现踝关节内翻畸形。合并腓骨骨折的患者发生 PPC 的几率是 7 倍。年龄、性别、受伤侧、损伤机制、初始移位量、受伤至手术的间隔时间或损伤能量均不会显著影响 PPC 的发生率。