经皮微创锁定加压钢板固定治疗学龄儿童胫骨远干骺端骨折

Minimally invasive percutaneous locking compression plate internal fixation in the treatment of metaphyseal fracture of distal tibia in children

目的 探讨经皮微创锁定加压钢板固定治疗儿童胫骨远干骺端骨折的疗效.方法 2006年1月至2008年6月采用闭合复位经皮插入锁定加压钢板内固定治疗儿童胫骨远干骺端骨折17例.男13例,女4例;年龄8岁7个月至14岁,平均12岁1个月.根据AO儿童长骨骨折分型：43-M/3.1型12例,43-M/3.2型3例.43t-M/3.1型2例;其中开放性骨折2例（Gustilo Ⅰ型）.结果 所有患儿均获随访.随访时间10～35个月,平均26个月;骨折均获骨性愈合,愈合时间2.5～4.2个月,平均3.2个月.根据美国足踝外科协会（AOFAS）评分系统对踝关节功能评分：优15例（88.2%）,良2例（11.8%）,优良率100%.伤侧肢体过度生长-5mm～11mm,平均3mm.切口浅表感染、内植物局部不适及内固定物取出困难各1例.无深部感染及皮肤坏死,未出现断钉、内同定松动及继发骨折移位,无骨折迟延愈合、不愈合、畸形愈合及内植物取出后再骨折,无踝关节内外翻畸形等并发症.结论 经皮微创锁定加压钢板同定治疗大龄儿童胫骨远干骺端骨折符合BO理念,具有创伤小、固定牢靠、有利于骨折愈合及软组织的修复、术后可早期行关节功能练习等优点,是一种有效的内固定方法.

Objective To explore the efficacy of minimally invasive percutaneous locking compression plate（LCP）internal fixation in the treatment of metaphyseal fracture of distal tibia in children.Methods Between January 2006 and June 2008,13 males and 4 females with metaphyseal fracture of distal tibia underwent minimally invasive percutaneous locking compression plate（LCP） internal fixation at this center. The average age of these patients was 12 years and 1 month old（range,8 years and 7 months to 14 years）.According to the AO comprehensive classification of pediatric long bone fractures,12 cases were classified as type 43-M/3.1,3 were 43-M/3.2 and 2 were 43t-M/3.1.Of the 17 patients,2 were open fracture（Gustilo type Ⅰ）.Results All the patients were followed up for an average period of 26 months（range,10 to 35 months）.All the fractures healed well and the average healing time was 3.2 months（range,2.5 to 4.2 months）.The ankle functions of the patients were evaluated according to the AOFAS scoring system.Fifteen patients＇ankle function（88.2%）were graded as excellent,2（11.8%）were good.The average leg length discrepancy was 3 mm（range,-0.5 to 11 mm）.Superficial infection occurred in 1 case.One patient felt uncomfortable around the implant.The implant was removed with some difficulties in 1 case.No Other complications were noted.Conclusions Minimally invasive percutaneous locking compression plate osteosynthesis is an effective treatment for metaphyseal fracture of distal tibia in children.