儿童胫骨下段骨折合并腓骨近端骨折9例

Lower tibial fracture plus proximal fibula fracture in children:a report of 9 cases

目的探讨儿童胫骨下段骨折合并腓骨近端骨折的临床特点与治疗效果。方法回顾苏州大学附属儿童医院2015年1月至2020年12月治疗的9例胫骨下段合并腓骨近端骨折患儿资料, 分析其临床诊疗与影像特点。其中男5例, 女4例, 平均年龄9.7岁。车祸伤3例, 运动损伤6例。8例为闭合性骨折, 1例为开放性骨折。2例患儿出现漏诊, 其中1例合并腓总神经损伤。胫骨下1/3骨干骨折8例, 下1/3合并胫骨远端骨骺骨折1例。X线片表现上, 9例患儿胫骨骨折线走行均为外上斜向内下;除3例腓骨青枝骨折, 6例腓骨骨折线为前高后低, 外高内低。术后随访以胫腓骨X线评价骨折复位与愈合情况, 以Johner-Wruh胫骨骨折愈合评定标准评价临床疗效。结果 4例采取石膏外固定, 5例采取手术固定胫骨(4例髓内钉, 1例髓内钉联合克氏针), 腓骨骨折均未采取内固定, 患儿平均随访时间为16.7个月, 范围为12~24个月。腓骨近端及胫骨骨折均愈合, 无伤口感染、骨折再移位及骨-筋膜室综合征等并发症, 腓总神经损伤患儿在伤后2个月症状消失。末次随访时, 根据Johner-Wruh胫骨骨折愈后评价标准, 其中优8例, 良1例。结论儿童胫骨下段斜形骨折有漏诊腓骨近端骨折可能, 应仔细检查, 选择恰当的拍片部位以减少漏诊。治疗上以复位固定胫骨为主, 腓骨骨折一般无需手术内固定治疗。

Objective To explore the clinical characteristics and treatment outcomes of lower tibial fracture plus proximal fibula fracture in children.Methods The clinical and radiological data were retrospectively reviewed for 9 children with lower tibial fracture plus proximal fibula fracture from January 2015 to December 2020.There were 5 boys and 4 girls with an average age of 9.7 years.The mechanism of injury included traffic accident(n=3)and sports activities(n=6).The specific fractures were closed(n=8)and open(n=1).Missed diagnosis was detected in 2 cases,including peroneal nerve injury(n=1).There were lower one-third diaphyseal fracture of tibia(n=8)and tibial shaft fracture plus distal tibial epiphysis fracture(n=1).On radiograph,tibial fracture line was oblique with high outside and low inside.Except for greenstick fractures(n=3),racture line of fibula was high anterolaterally and low posteromedially(n=6).Radiography was performed for evaluating the status of reduction and healing.And Johner-Wruh's criteria were applied for evaluating the clinical outcomes during postoperative follow-ups.Results The procedures included cast fixation(n=4)and surgery for tibia with internal fixation(n=5).The latter included intramedullary nailing(n=4)and intramedullary nailing plus Kirschner wire(n=1).Cast immobilization was performed for fibula fracture.The mean follow-up period was 16.7(12-24)months.All fibula and tibial fractures healed without wound infection,fracture re-displacement or osteofascial compartment syndrome.The symptoms of peroneal nerve injury disappeared at Month 2 post-injury.At the last follow-up,according to the Johner-Wruh criteria of tibial fracture evaluation,the outcomes were excellent(n=8)and decent(n=1).Conclusions In children with oblique fracture of lower tibia,proximal fibular fracture mayt be missed.Meticulous physical examinations and proper selections of appropriate radiographic sites should be performed to minimize its occurrence.Restoring alignment and stabilizing tibial fracture is a major therapeutic goal.Surgical fixation is generally not required for proximal fibula fractures.