儿童胫骨远端骨骺骨折的闭合治疗

目的探讨儿童胫骨远端骨骺骨折闭合治疗方法及治疗效果。方法选取我院于1998年1月至2008年1月收治的儿童胫骨远端骨骺骨折206例,根据Salter——Harris分型标准,I型11例,Ⅱ型178例,Ⅲ型16例(其中Tillaux骨折5例,三平面骨折1例),Ⅳ型1例。均采用闭合手法复位和石膏固定治疗。结果206例均获随访,时间6～36个月,平均14个月。其中优203例,良1例,差2例。结论儿童胫骨远端骨骺骨折多数可采用闭合手法复位,确切石膏固定,而取得满意疗效。Ⅰ、Ⅱ型损伤即使不能良好复位,后期施行截骨术矫正畸形要比反复暴力复位损伤骺板的结果好。Ⅲ型、Ⅳ型如移位明显经手法不能复位者应采取切开复位。避免片面强调解剖复位造成骺板的医源性损伤。在骺板分离状态下手法整复和石膏固定,是减轻生发层受到挤压的有益措施,有利于骨折愈合和骨骺发育。

Objective This paper study how to treat the epiphyseal fracture of distal tibia by the closed reduction and evaluate the different therapeutic method. Methods From January, 1998 to January, 2008 206 patients with epiphyseal injuries of distal tibia were treated in our hospital. According to Salter--Harris＇criterion of trauma type, 11 cases are type Ⅰ , type Ⅱ 178 cases, type Ⅲ 16 cases（5 cases are Tillaux fracture, triplane fracture 1 case）, type Ⅳ 1 case. All patients adopt the closed reduction and plaster fixation.Results The average period of the follow up of 206 patients was 14 months（range, 6-36months）.The recover of 203 cases are excellent, 1 are good and 2 peor.Conclusion Most epiphyseal fractures of distal tibia in children will get the good therapeutic effects by the closed reduction and accurate plaster fixation. Even type I and typeII can not get the good reduction, the osteotomy correction of deformities is better than the repeated forced-reduction. Type Ⅲ and type Ⅳ need the opened reduction if they can not be treated by the closed reduction easily. To the epiphyseal fracture, the closed reduction and plaster fixation will avoid the extrusion of the germial layer, which is helpful for the fracture healing and the epiphyseal growth.