摘要
目的对闭合复位石膏固定及关节镜下复位可吸收钉固定治疗新鲜MeyersⅢ型儿童胫骨髁间棘骨折进行临床疗效比较。
方法2010年6月至2013年6月间我科接诊的新鲜MeyersⅢ型儿童胫骨髁间棘骨折患儿，在关节镜组医生首诊的患儿共12例（12膝），进行关节镜下复位可吸收钉固定，均获得随访，作为I组；同期非关节镜组医生首诊的患儿共19例（19膝），进行闭合复位石膏固定治疗，其中16例（16膝）获得随访，按照年龄（±1岁）、性别选择其中的12例与I组进行匹配，作为II组。Lysholm评分评价膝关节功能，Lachnmn试验、轴移试验评价膝关节稳定性，KT1000记录双侧膝关节松弛度差异，术后平片按照Wilfinger给出的X线评价标准分级，评价骨折愈合情况及是否存在骨骺早闭。应用PASS软件（V11.0.7，美国NCSS公司）确定所需样本量。应用两个独立样本Wilcoxon秩和检验对两组Lysholm评分进行分析，应用两个独立样本t检验对两组KT1000测量值进行分析，应用Fisher精确概率χ2检验对两组Wilfinger X线分级C及D级占比进行分析。
结果男性每组各4例，女性每组各8例；年龄8～14岁，平均年龄10岁3个月。平均随访时间24个月（18～48个月）。I组12例骨折均获得并维持满意的复位，无内固定断裂、骨块松动、感染、滑膜炎等并发症发生，末次随访时无关节活动受限，膝关节Lysholm功能评分（97.5±2.0）分，Lachnmn试验、轴移试验均阴性，术后3个月内X线显示骨性愈合，按照Wilfinger给出的X线评价标准A 6例，B 4例，C 2例，末次随访时X线检查未见骺板早闭现象。II组末次随访时2例存在5°～10°伸直受限，Lysholm膝关节功能评分（88.0±7.2）分，与I组比较差异具有统计学意义（U＝16.500，W＝94.500，Z＝－3.273，P＝0.001〈0.05）, Lachnmn试验5例阳性、轴移试验2例阳性，X线评价B 2例，C 6例，D 4例，两组Wi
ObjectiveTo compare the efficacies of arthroscopic reduction with internal fixation using bioabsorbable nails （group I） versus closed reduction with cast immobilization （group II）.MethodsA retrospective case-control study was conducted for type III tibial spine fractures according to the Meyers criteria. Twelve skeletally immature patients undergoing arthroscopic reduction with internal fixation using bioabsorbable nails （group I） were compared with 12 age and gender-matched skeletally immature counterparts undergoing closed reduction with cast immobilization （group II）. During a follow-up period of 18-48 months, all subjects were evaluated with anterior knee laxity （Lachnmn ＆ pivot-shift tests）, range of motion, Lysholm knee scoring scale and Wilfinger X-ray classification.ResultsSignificant inter-group differences existed in range of motion （0/12 vs 2/12）, Lysholm knee scoring scale （U=16.500, W=94.500, Z=-3.273, P=0.001〈0.05） and X ray（χ2=10.667, P=0.003〈0.05）. The range of motion was normal for all knee joints. The functions of all knees were excellent according to the Lysholm knee scoring scale. Only 2 were fair or poor according to the Wilfinger X-ray classification. There was no inflammation and all fractures healed without complications. In group II, Lachnmn test （n=5） and pivot-shift test （n=2） were positive. In 2 patients, the range of motion was abnormal for knee joints （5-10 degree limited extension）. Three of them were fair according to the Lysholm knee scoring scale. And 10/12 patients were fair or poor according to the Wilfinger X-ray classification.ConclusionsAs compared with closed reduction with cast immobilization, arthroscopic reduction with internal fixation for tibial spine fractures can regain full stability and good function of knee joint. Bioabsorbable nail has the advantages of simpler handling and more stable fixation. Thus a second operation for removing metallic implants is avoided.
作者
冯超
万世奇
郭源
田伟
Feng C Wan SQ Guo Y Tian W(Department of Pediatric Orthopedic Surgery Department of Spine Surgery , Beijing Jishuitan Hospital, Beijing 100035, China)
出处
《中华小儿外科杂志》
CSCD
2017年第5期324-330,共7页
Chinese Journal of Pediatric Surgery
关键词
外科手术
关节镜
儿童
胫骨骨折
Surgical procedures, arthroscopic
Child
Tibial fractures
