儿童开放Seymour骨折的近期随访研究

Short-term follow-ups of pediatric open Seymour Fracture

目的探讨儿童开放Seymour骨折的一般规律、有效治疗方法、早期随诊结果及并发症。方法收集2016年9月至2017年5月在本院行早期清创复位固定治疗的21例儿童开放Seymour骨折患儿作为研究对象。收集患儿术前人口学资料、影像学资料、术后功能、满意度评分及并发症情况。该组患儿年龄中位数为8岁(1～14岁),平均随访时间5个月(4～20个月)。早期予以清创、解除软组织嵌压、复位、克氏针内固定、拔甲、甲床甲根修补及石膏固定。结果 21例患儿中,11例为SalterHarrisⅠ型骺损伤,10例为Salter-HarrisⅡ型骺损伤。21例均合并甲床损伤,其中9例还合并周围皮肤软组织裂伤。固定方式:15例(72%)采用单枚克氏针贯穿固定,6例(28%)采用交叉克氏针固定。20例获得随访。术后17例获得完整远指间关节活动度,18例随访时无疼痛。2例术后发生感染。所有患儿获得影像学愈合,总体满意度9. 3分(8～10分)。术后指甲并发症14例,但均未影响功能及满意度。结论 Seymour骨折需早期清创复位固定。感染和指甲并发症为Seymour骨折的常见并发症。经早期正规处理的该型骺损伤短期功能及满意度好,但应继续随访其是否发生远期并发症,且应认识到感染及指甲相关并发症都可在晚期出现。

Objective To explore the general rules,effective treatments,early results and complicationsof children with open Seymour fractures. Methods Twentyone children with open Seymour fractures undergoing debridement and reduction from September 2016 to May 2017 were collected for followups of 5 （4 ～ 20）months. Preoperative epidemiological data,imaging examinations,postoperative functions,satisfaction scores andcomplications were analyzed. The average age was 8 （1 ～ 14） years. Early debridement,release of soft tissue indentation,reduction,Kirschner wire internal fixation, nail extraction, nailbed repair and cast immobilizationwere performed. Results Epiphysis injuries belonged to SalterHarris type Ⅰ （ n = 11） and type Ⅱ （ n =10）. All of them showed nail bed injury and 9 also had soft tissue laceration around skin. Fixation methods weresingle Kirschner wire （n = 15,72%） and crossed Kirschner wire （ n = 6,28%）. Twenty cases were followedup. 17 patients had complete distal interphalangeal joint mobility and 18 were painfree. Two cases developedpostoperative infection. All of them achieved imaging healing with an overall satisfaction of 9. 3（8 ～ 10） points.There were 14 cases of postoperative nail complications,but function and satisfaction were not affected. Conclusion Seymour fractures require early debridement,reduction and fixation. Infection and nail complicationsare common. Shortterm function and satisfaction are excellent after early formal treatment. Longterm followupsfor complications are necessary.