长腿与短腿石膏固定用于闭合复位后治疗儿童胫骨远端Salter-Harris II型骨折：一项多中心回顾性研究
Long Leg Versus Short Leg Cast Immobilization for Treatment of Salter-Harris II Distal Tibial Fractures After Closed Reduction: A Multisite Retrospective Study.
作者信息
Souder Christopher D, Spearman James D, Garza Holly Hughes, Thornton Lori A, Treiber Jessica M, Bloomer Ainsley, Scannell Brian P, Ho Christine A
机构信息
Department of Orthopaedic Surgery, UC San Diego, Rady Children's Hospital, San Diego, CA, USA.
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA.
出版信息
J Pediatr Soc North Am. 2024 Jul 14;8:100092. doi: 10.1016/j.jposna.2024.100092. eCollection 2024 Aug.
BACKGROUND
Distal tibial physeal fractures are common injuries that can frequently be treated nonoperatively. Most commonly, long leg cast (LLC) immobilization is recommended after closed reduction. The purpose of this study was to compare outcomes between LLC and short leg cast (SLC) immobilization after closed reduction of Salter-Harris II (SH-II) distal tibial fractures.
METHODS
A retrospective, multicenter comparative study was performed evaluating skeletally immature patients treated with closed reduction of a displaced SH-II distal tibia fracture at 3 level I Pediatric Trauma Centers between 2012 and 2018. Radiographs after casting were compared with those at the time of cast removal to assess the primary study outcome of loss of reduction (LOR). Secondary outcomes included the length of casting, premature physeal closure, time to weightbearing, and time to release to activities.
RESULTS
A total of 148 patients with a median age of 12.7 years (interquartile range 11.2-13.7) met the inclusion criteria. LLC were utilized in 110 cases while 38 patients received an SLC. LOR occurred in 10 patients (6.8%), 9 with an LLC and 1 in an SLC ( = .454). Those treated in SLC had a shorter length of casting ( = .030) and quicker release to activities ( = .004) than those with LLC.
CONCLUSIONS
Findings of this retrospective, multicenter study show similar rates of LOR between SLC and LLC immobilization for SH-II distal tibial fractures after closed reduction. Patients received less total casting and returned to sports quicker after SLC immobilization.
KEY CONCEPTS
(1)Salter-Harris II (SH-II) distal tibia fractures can be treated with closed reduction and short leg casting without an increased rate of displacement(2)Distal tibial physeal fractures treated in a short leg cast can possibly return to sports quicker(3)The rate of interval displacement of an SH-II distal tibia fracture after closed reduction is approximately 6.7%.
LEVEL OF EVIDENCE
III, Retrospective Comparative Study.
背景
胫骨干骺端骨折是常见损伤，通常可采用非手术治疗。最常见的是，闭合复位后建议使用长腿石膏（LLC）固定。本研究的目的是比较Salter-Harris II型（SH-II）胫骨干骺端骨折闭合复位后使用LLC和短腿石膏（SLC）固定的疗效。
方法
进行了一项回顾性、多中心比较研究，评估2012年至2018年期间在3家I级小儿创伤中心接受移位性SH-II胫骨干骺端骨折闭合复位治疗的骨骼未成熟患者。将石膏固定后的X线片与拆除石膏时的X线片进行比较，以评估复位丢失（LOR）这一主要研究结果。次要结果包括石膏固定时间、过早骨骺闭合、负重时间和恢复活动时间。
结果
共有148例患者符合纳入标准，中位年龄为12.7岁（四分位间距11.2-13.7）。110例患者使用LLC，38例患者使用SLC。10例患者（6.8%）出现LOR，9例使用LLC，1例使用SLC（P=0.454）。与使用LLC的患者相比，使用SLC治疗的患者石膏固定时间更短（P=0.030），恢复活动更快（P=0.004）。
结论
这项回顾性多中心研究的结果表明，SH-II胫骨干骺端骨折闭合复位后，SLC和LLC固定的LOR发生率相似。使用SLC固定的患者石膏固定总时间更短，恢复运动更快。
关键概念
（1）Salter-Harris II型（SH-II）胫骨干骺端骨折可通过闭合复位和短腿石膏固定治疗，且移位率不会增加。（2）采用短腿石膏固定治疗的胫骨干骺端骨折患者可能恢复运动更快。（3）SH-II胫骨干骺端骨折闭合复位后的间隔移位率约为6.7%。
证据水平
III级，回顾性比较研究。
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