晚期就诊的股骨远端关节内骨骺骨折的手术治疗结果：一项多中心回顾性病例系列研究
Outcomes of Surgical Management of Late Presenting Intra-Articular Distal Femoral Physeal Fracture: A Multicentric Retrospective Case Series.
作者信息
Singh Jaswinder, Shah Hitesh, Venkatadass K, Bhadani Janki Sharan, Mukhopadhaya John
机构信息
Department of Orthopaedics, Paras HMRI Hospital, Raza Bazaar, Patna, 800014 Bihar India.
Department of Paediatric Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, 576104 Manipal, India.
出版信息
Indian J Orthop. 2025 Jan 20;59(3):426-437. doi: 10.1007/s43465-024-01324-y. eCollection 2025 Mar.
INTRODUCTION
Distal femur physeal fractures in children, particularly Hoffa fractures, are rare and prone to complications. This study aims to evaluate the outcomes of surgical intervention in children presenting with delayed intraarticular distal femur physeal fractures.
MATERIALS AND METHODS
A multicentric retrospective study involving six pediatric patients with delayed presentation of distal femur physeal fractures was conducted. Five patients underwent surgical intervention involving osteotomy and anatomical refixation of the malunited fragments. One patient opted for conservative management. The age at presentation, time since injury, surgical procedures, and clinical and radiological outcomes were evaluated at the final follow-up. Fixation with lag screws was sufficient in three patients, while two required additional plate stabilization.
RESULTS
The mean age of patients was 12.2 years, comprising four boys and two girls. The average delay in presentation was 30.8 months (ranging from 3 months to 8 years). For the surgical group ( = 5), the knee range of motion improved from an average of 16-66 degrees preoperatively to 6-128 degrees postoperatively at a mean follow-up of 60 months. The mean limb shortening was 3 cm (range 0.5-5 cm). Two patients required additional procedures for distal femur varus malalignment. The conservatively managed patient showed no improvement in knee movements at the 12 month follow-up, serving as a control.
CONCLUSIONS
Surgical intervention involving osteotomy and anatomical reduction for malunited intraarticular Salter-Harris type III and IV fractures of the distal femur in children yields good to excellent outcomes. Limb length discrepancy and malalignment, if present, can be addressed separately. Longer follow-up until skeletal maturity is necessary to evaluate final outcomes in these patients.
LEVEL OF EVIDENCE
Level IV (Case series). Therapeutic.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-024-01324-y.
引言
儿童股骨远端骨骺骨折，尤其是霍法骨折，较为罕见且易引发并发症。本研究旨在评估手术干预对延迟出现的股骨远端关节内骨骺骨折患儿的治疗效果。
材料与方法
开展一项多中心回顾性研究，纳入6例股骨远端骨骺骨折延迟就诊的儿科患者。5例患者接受了手术干预，包括截骨术及对愈合不良骨折块的解剖复位固定。1例患者选择保守治疗。在末次随访时评估患者的就诊年龄、受伤时间、手术方式以及临床和影像学结果。3例患者单纯使用拉力螺钉固定即可，另外2例则需要额外的钢板固定。
结果
患者平均年龄为12.2岁，其中4例男孩，2例女孩。平均就诊延迟时间为30.8个月（范围为3个月至8年）。手术组（n = 5）在平均60个月的随访中，膝关节活动范围从术前平均16° - 66°改善至术后6° - 128°。平均肢体短缩3 cm（范围0.5 - 5 cm）。2例患者因股骨远端内翻畸形需要再次手术。保守治疗的患者在12个月随访时膝关节活动无改善，作为对照。
结论
对于儿童股骨远端关节内Salter - Harris III型和IV型骨折愈合不良进行截骨术及解剖复位的手术干预可取得良好至极佳的效果。肢体长度差异和畸形（若存在）可分别处理。需要更长时间的随访直至骨骼成熟，以评估这些患者的最终结局。
证据级别
IV级（病例系列）。治疗性。
补充信息
在线版本包含可在10.1
Zotero 插件