锁定钢板经皮外固定治疗儿童胫骨骨折

Locking plate percutaneous external fixation for the treatment of pediatric tibial fractures

目的：探讨锁定钢板经皮外固定治疗儿童胫骨骨折的效果。方法：回顾2010年7月至2013年2月采用锁定钢板经皮外因定治疗儿童胫骨骨折8例，均为单侧；男6例，女2例；年龄4～10岁，平均7岁。开放性骨折5例按照Gustilo-Anderson分型：Ⅱ型1例，ⅢA型3例，ⅢB型1例；闭合性骨折3例按照AO分型：A3型2例，B2型1例。术后观察骨愈合情况及步态影响，采用Johner-Wruhs评定标准对疗效进行评价。结果：8例患者骨折均愈合，未发生感染。骨折愈合时间3-6个月，平均3．9个月；锁定钢板拆除时间4-7个月，平均4．3个月。7例带架行走后目测走态正常，另l例因胫前肌腱缺失，影响步态。对侧小腿内侧皮肤未见擦伤痕。8例患者获随访，时间6个月～1年，依据Johner-Wmhs疗效评价标准，结果优7例，良1例。结论：锁定钢板经皮外固定操作简便，对于儿童胫骨骨折固定稳定可靠，术后功能恢复好，带钢板行走时步态影响较小，但LCP钢板置钉点固定，要求在安装前完成骨折的复位并确定置钉处有完好的皮肤覆盖。

To explore treatment effect of the locking plate percutaneous external fixation to tibial fractures. Methods：From July 2010 to February 2013,8 cases with pediatric tibial fractures were treated by using unilateral locking plate percutaneous external fixation,including 6 males and 2 females with an average age of 7 years old ranging from 4 to 10. Among them, 5 cases were open fractures involving 1 case of Gustilo-Anderson type 1I , 3 cases of type ~ A, ! case of type In B ; and the other 3 cases were closed fractures involving 2 cases of AO type A3,1 cases of type B2. The postoperative bone healing and gait impact were observed and the function was evaluated by Johner-Wruhs scores. Results：All fractures healed successfully without infection. The fracture healing time was from 3 to 6 months with an average of 3.9 months. The locking plate removal time was from 4 to 7 months with an average of 4.3 months. Among them, 7 cases were visually normal after walking with stand, 1 case of anterior tibial tendon defect affected gait. The results of Johner-Wrnhs assessment were excellent in 7 cases, good in 1 case. No rub contralateral medial calf skin wounds occurenced. Conclusion： The method is simple, stable and reliable. The fixation strength is suitable for children using locking plate percntaneous external fixation. The postoperative functional recovery was excellent and the walking gait was less affected. But the point of LCP pedicle screw should be carefully selected before installation with good skin coverage.