儿童漂浮膝的治疗方案及疗效分析

Treatment strategies and therapeutic effects in treatment of floating knee in children

目的探讨儿童漂浮膝的治疗方案及治疗效果。方法采用回顾性病例系列研究分析2006年7月— 2015年6月治疗的26例儿童漂浮膝患者，其中男22例，女4例；年龄2～14岁，平均7.6岁。单侧25例，双侧1例。按Letts分型：A型10例，B型4例，C型2例，D型8例，E型2例。闭合性骨折16例，开放性骨折10例。开放性骨折采用Gustilo分型：ⅢA型1例，ⅢB型6例，ⅢC型3例。1例截肢，8例采用牵引石膏固定，17例股骨、胫骨骨折同时开放或闭合复位固定。观察肢体伤口愈合情况、骨折愈合情况，根据Karlstrom肢体功能评定标准综合评价漂浮膝的恢复情况，记录主要并发症。结果26例均获随访1～6年，平均2.8年。1例ⅢA型、6例ⅢB型开放性损伤均Ⅰ期清创缝合后愈合；3例ⅢC型损伤中2例Ⅱ期植皮后伤口愈合，1例截肢创面感染，再次清创、伤口处换药愈合。骨折均愈合，2例延迟愈合。依据Karlstrom膝关节功能评定标准，非手术治疗优良率25%（2/8），手术治疗优良率83%（15/18）（P〈0.05）。4例畸形愈合，3例膝外翻，7例过度生长10～20 mm，无骨骺早闭。结论对于儿童漂浮膝，股骨、胫骨均复位固定，利于骨折的愈合及关节功能的恢复，效果满意。

Objective To investigate the treatment strategies and clinical effects in treatment of floating knee in children. Methods A retrospective case series study was made on 26 cases of floating knee treated from July 2005 to June 2015. There were 22 males and four females, aged from 2-14 years （mean, 7.6 years）. According to the Letts classification of the floating knee, ten cases were with type A, four with type B, two with type C, eight with type D, hnd two with type E. Closed fractures were noted in 16 cases and open fractures in 10 cases. According to the Gustilo classification of open fractures, one was with type m A, six with type ill B, and three with type ⅢC. One case was amputated from the distal of the femur, eight cases were treated by traction and plaster caster, and 17 cases were treated by reduction and fixation of both femoral and tibil fractures. Wound healing, fracture union, Karsstrom criteria for functional outcome and complications were detected. Results All patients were followed up for mean 2.8 years （ range, 1-6 years）. One case of Gustilo type m A and six cases of Gustilo type Ⅲ B open fractures had wound healing after one-stage debridement. Two cases of Gustilo type m c showed wound healing after second-stage skin grafting. One case of Gustilo type Ⅲ C had amputation wound infection and was cured after a second debridement and dress change. Two had delayed union and there was no nonunion. According to the Karlstrom criteria, the excellent and good rate of functional outcome was 25% and 83% respectively in nonoperative and operative population （ P 〈 0.05 ）. Malunion was found in four cases, genu vagum in three and overgrowth of 10-20 mm in seven. There was no premature closure of epiphysis. Conclusion Femur and tibia immobilization of floating knee in children is effective for bone union and functional recovery.