Davids J R
Shriner's Hospital for Crippled Children, Greenville, South Carolina.
Clin Orthop Relat Res. 1994 May(302):27-35.
The remodeling potential of angular deformities in the coronal and sagittal planes in children is widely appreciated, and has been studied extensively. The short-term clinical consequences and remodeling potential of torsional deformity after fracture of the femur are less well understood. Computerized axial tomography (CT) was used to identify and follow children with torsional malunion after standard treatment (traction/spica cast) of a closed femur fracture. Seven fracture patients with torsional differences greater than 10 degrees were selected and observed. Computed axial tomography scans were performed at the time of spica cast removal and at the one-year follow-up examination. Four cases showed diminished femoral torsion (one case retroversion), and three cases showed increased femoral torsion. The deformity ranged from 13 degrees to 38 degrees. Follow-up CTs one year later showed no significant correction of deformity. Clinically, deformity of up to 25 degrees was well tolerated. The only symptomatic patient (38 degrees malunion) had a third CT done 28 months after injury, which showed no further correction of deformity. This study confirms the poor remodeling potential of significant posttraumatic torsional deformity of the femur in children.
儿童冠状面和矢状面角畸形的重塑潜力已得到广泛认可，并已进行了广泛研究。股骨骨折后扭转畸形的短期临床后果和重塑潜力则了解较少。采用计算机断层扫描（CT）来识别和随访闭合性股骨骨折经标准治疗（牵引/髋人字石膏）后发生扭转畸形愈合的儿童。选择并观察了7例扭转差异大于10度的骨折患者。在拆除髋人字石膏时及随访1年时进行计算机断层扫描。4例显示股骨扭转减小（1例为前倾减小），3例显示股骨扭转增加。畸形范围为13度至38度。1年后的随访CT显示畸形无明显矫正。临床上，高达25度的畸形耐受性良好。唯一有症状的患者（畸形愈合38度）在受伤28个月后进行了第三次CT检查，结果显示畸形无进一步矫正。本研究证实儿童股骨创伤后明显扭转畸形的重塑潜力较差。
