髂前上棘撕脱骨折18例治疗回顾

Treatment of 18 cases with anterior superior iliac spine avulsion fracture： a respective review

目的回顾18例髂前上棘（anterior superior iliac spine,ASIS）撕脱骨折的治疗，分析小儿髂前上棘撕脱骨折受伤机制，手术治疗的效果、预后、并发症。方法2003年7月至2013年7月复旦大学附属儿科医院共收治髂前上棘撕脱骨折患儿18例。男15例，女3例，年龄3岁8个月至16岁。均为急性损伤：快速跑步时或急加速时14例，打篮球突然跳跃1例，踢球1例，车祸伤2例。X线片及CT了解骨折片的大小及移位情况：2例车祸伤者1例因合并股骨颈骨折行股骨颈切开复位空心钉内固定术，髂前上棘撕脱未处理，1年后X片及CT发现形成骨化中心，无症状未处理；1例行保守治疗骨折愈合；其余均行切开复位空心钉内固定。结果18例患儿治疗效果优良，术后无深部组织感染，髋关节无活动受限，肌力正常，运动能力恢复，局部无疼痛、无包块。结论髂前上棘撕脱骨折切开复位空心钉内固定效果好，恢复快，并发症少，并且可避免以后可能出现的股外侧区疼痛症，运动员可尽早恢复训练，但需二次手术取出内固定。

Objective To retrospectively review the treatment experiences of 18 cases of anterior superior iliac spine （ASIS） avulsion fracture so as to analyze its injury mechanism, treatment, complications and prognosis. Methods The clinical follow-up data were collected for 18 children with ASIS avulsion fracture treated at Childrer＇s Hospital, Fudan University during the period of July 2003 to July 2013. There were 15 males and 3 females with an age range of 44 192 months. All of them had acute injuries from rapid running or sudden acceleration （n = 14）, sudden jumping while playing basketball （n = 1）, football-related （n = 1） and traffic accident （n = 2）. Radiology and computed tomography （CT） scan were used to analyze the size of bone fragments and shifting. One traffic accident patient coupled with femoral neck fractures underwent femoral neck open reduction and cannulated screw fixation while ASIS avulsion was untreated. One year later, radiology and CT showed heterotopic ossification at iliac spine. For asymptomatic patients, no treatment was offered. Another patient of traffic accident received routine conservative treatment for fracture healing. And the remainder underwent open reduction and cannulated screw fixation. Results The treatment efficacies of all cases were excellent without hip activity limitation or local pain or mass or deep tissue infection after operation. Conclusions Treating ASIS avulsion fracture with open reduction and cannulated screw fixation has a definite efficacy with faster recovery and fewer complications. Meanwhile it avoids pain in lateral femoral region. The athletes may return to their training as soon as possible. But internal fixationt needs extraction through a second operation.