外固定架治疗儿童不稳定骨盆骨折的疗效。

Therapeutic effect of an external fixator in the treatment of unstable pelvic fractures in children.

机构信息

Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, 100045 Beijing, China.

出版信息

Orthop Traumatol Surg Res. 2022 Oct;108(6):103150. doi: 10.1016/j.otsr.2021.103150. Epub 2021 Nov 24.

DOI:10.1016/j.otsr.2021.103150

PMID:34838753

Abstract

BACKGROUND

Unstable pelvic fractures in children are serious and complex injuries, and the optimal method to manage these injuries is controversial.

HYPOTHESIS

We hypothesized that an external fixator would be a satisfactory method of treating unstable pelvic fractures in children.

PATIENTS AND METHODS

We retrospectively reviewed 40 pediatric patients with unstable pelvic fractures who were treated with an external fixator in Beijing Children's Hospital from June 2006 to June 2016. Postoperative follow-up was 12 to 108 months, with an average of 26 months. One year after the operation, fracture healing, pelvic asymmetry, and deformity index were assessed by X-ray. Pelvic function was evaluated with the Cole evaluation standard, and daily cognitive and motor functions were evaluated by weeFIM. Patient complications were recorded.

RESULTS

The average age of the 40 patients was 5.9±3.1 years (2 to 14.5), including 25 boys and 15 girls. Among these cases, 37 (92.5%) had injuries caused by traffic accidents and 3 (7.5%) had injuries caused by falling from height. Based on the Tile classification, there were 18 cases of class B (14 class B2 and 4 class B3) and 22 cases of class C (15 class C1, 6 class C2, and 1 class C3). The X-rays showed good fracture healing at the 1-year postoperative follow-up. The pelvic asymmetry was reduced from 1.13cm before the operation to 0.88cm after (p<0.05), and the deformity index was decreased from 0.09 before to 0.05 after the operation (p<0.05). At the 1-year postoperative follow-up, 36 patients had excellent Cole scores, and 4 had good Cole scores, with a good or excellent rate of 100%. According to the weeFIM, 28 patients had complete independence, 11 had basic independence, and 1 had conditional independence. Three patients (7.5%) had complications, all of which were postoperative pin-site infections.

DISCUSSION

For children with horizontally unstable pelvic fractures, an external fixator can be used alone. For children with horizontally and vertically unstable pelvic fractures, after external fixator placement and reduction, lower extremity traction can be performed to achieve better reduction and maintain stability, and the therapeutic effect is satisfactory.

LEVEL OF EVIDENCE

IV, retrospective observational cohort study.

摘要

背景

儿童不稳定骨盆骨折是严重且复杂的损伤，其最佳治疗方法存在争议。

假设

我们假设外固定器将是治疗儿童不稳定骨盆骨折的一种满意方法。

患者和方法

我们回顾性分析了 2006 年 6 月至 2016 年 6 月在北京儿童医院接受外固定器治疗的 40 例儿童不稳定骨盆骨折患者。术后随访 12 至 108 个月，平均 26 个月。术后 1 年，通过 X 线评估骨折愈合、骨盆不对称和畸形指数。采用 Cole 评价标准评估骨盆功能，采用 weeFIM 评价日常认知和运动功能。记录患者并发症。

结果

40 例患者的平均年龄为 5.9±3.1 岁（2 至 14.5 岁），其中男 25 例，女 15 例。这些病例中，37 例（92.5%）因交通事故受伤，3 例（7.5%）因高处坠落受伤。根据 Tile 分类，B 型 18 例（14 例 B2 型和 4 例 B3 型），C 型 22 例（15 例 C1 型、6 例 C2 型和 1 例 C3 型）。X 线显示术后 1 年骨折愈合良好。骨盆不对称从术前的 1.13cm 减少到术后的 0.88cm（p<0.05），畸形指数从术前的 0.09 减少到术后的 0.05（p<0.05）。术后 1 年随访时，36 例患者 Cole 评分优秀，4 例患者 Cole 评分良好，优良率 100%。根据 weeFIM，28 例患者完全独立，11 例患者基本独立，1 例患者有条件独立。3 例（7.5%）患者出现并发症，均为术后针道感染。