儿童胫骨上段骨折后并发膝外翻畸形的微创治疗

Mini-invasive treatment of cross-knee after proximal tibial fracture in children

目的探讨儿童胫骨上段骨折后并发膝外翻畸形的形成原因及微创治疗方法。方法对我院2008年10月～2010年10月间收治的胫骨上端骨折并发膝外翻畸形患儿进行了回顾性分析。本组患儿共12例,男性8例,女性4例,均采用"8"字钢板于胫骨上段内侧骺板行骨骺阻滞术。结果 8例随访2年。1例(11岁)单侧肢体外伤后膝外翻畸形患儿矫正术后1年不满意,后行胫骨近端截骨矫形手术;1例(6岁)单膝外翻,因钢板安置不理想,矫正不满意,1.5年后重新调整钢板;其余6例术后2年测踝间距均减少至2cm以下,已拆除"8"字钢板,膝外翻完全纠正,效果满意。4例随访1年,均按预期矫正观察中。结论应用"8"字钢板进行暂时性骨骺阻滞纠正儿童胫骨上段骨折并发膝外翻畸形是一种微创、安全、效果确切的治疗方法。为保证矫形术后效果满意,应在术后行患肢石膏固定2～3周。此类手术操作简单易行,值得推广。

Objective To discuss the causes and mini-invasive treatment methods of cross-knee after proximal tibial fracture in children.Methods Retrospective analysis was conducted in 12 children（8 males and 4 females） who were admitted into our hospital due to proximal tibial fracture combined with cross-knee from Oct.2008 to Oct.2010.＂8＂-shaped plate was applied for Epiphyseal arrest surgery in the proximal tibia.Results Eight children were followed up for two years.One patient was re-performed proximal tibial osteotomy due to unsatisfied result of epithesis for cross-knee after the lateral limb injury;one patient（6 years old） was re-adjusted plate 1.5 years after injury,due to un-satisfied plate placement and epithesis;for the other 6 patients,the intermalleolar distance was reduced to be less than 2cm 2 years after operation,and ＂8＂ shaped plate was removed and cross-knee was fully corrected.The remaining 4 patients were followed up for 1 year.All the 4 patients were being under observation for correction surgery.Conclusion Applying Epiphyseal arrest surgery with ＂8＂-shaped plate for cross-knee after proximal tibial fracture in children is a mini-invasive,safe and effective treatment method.In order to achieve satisfied postoperative effect,the injured limbs should be fixed with gypsum for 2-3 weeks.In a word,this method is a simple and convenient procedure,and it is worthy to be applied.