组合式桥接内固定系统固定治疗儿童四肢干骺端骨折

Composite bridge internal fixation for limb metaphyseal fractures in children

目的探讨组合式桥接内固定系统固定治疗儿童四肢干骺端骨折的疗效。方法回顾性分析2015年10月至2018年12月期间南京医科大学附属常州第二人民医院骨科采用组合式桥接内固定系统固定治疗的16例儿童干骺端骨折患者资料。男11例,女5例;年龄为8~14岁,平均11.0岁。骨折部位:肱骨近端4例,股骨远端3例,胫骨近端3例,胫骨远端6例;骨折按Salter-Harris分型:Ⅱ型6例,Ⅲ型5例,Ⅳ型5例。受伤至手术时间为3~8 d,平均5.3 d。记录患者的骨折愈合时间、并发症发生情况(术后感染、内固定失效)及术后功能恢复情况等。结果16例患者术后获12~18个月(平均13个月)随访。16例儿童患者术后均获骨性愈合,骨折愈合时间为2~5个月(平均2.4个月)。末次随访时4例肱骨近端骨折患者根据Neer评分标准评定疗效:均为优;6例股骨远端骨折或胫骨近端骨折患者根据美国特种医院膝关节功能评分标准评定疗效:优5例,良1例;6例胫骨远端骨折患者根据Baird评分标准评定疗效:优5例,良1例。随访过程中无一例患者发生术后感染、断钉、断棒及骨折不愈合等并发症。结论组合式桥接内固定系统固定治疗儿童干骺端骨折具有微创、操作简单、固定可靠及并发症少等优点,是儿童干骺端骨折的一种可选治疗方案。

Objective To evaluate composite bridge internal fixation in the treatment of limb metaphyseal fractures in children.Methods From October 2015 to December 2018,16 children was treated by composite bridge internal fixation for limb metaphyseal fractures at Department of Orthopaedics,The Second People's Hospital of Changzhou.They were 11 boys and 5 girls,aged from 8 to 14 years(average,11.0 years).Their fractures were located at proximal humerus in 4 cases,at distal femur in 3 cases,at proximal tibia in 3 cases and at distal tibia in 6 cases.According to the Salter-Harris classification,6 cases were typeⅡ,5 cases typeⅢand 5 cases typeⅣ.The time from injury to surgery ranged from 3 to 8 days,averaging 5.3 days.The fracture healing time,postoperative complications(infection and implant failure)and postoperative functional recovery were recorded.Results This cohort obtained follow-up from 12 to 18 months(average,13 months).All the children obtained bony union after 2 to 5 months(average,2.4 months).At the last follow-up,the 4 proximal humeral fractures were evaluated by the Neer scores,giving 4 excellent cases;the 6 distal femoral and proximal tibial fractures were evaluated by the knee function scores of The Hospital for Special Surgery(HSS),giving 5 excellent and one good cases;the 6 distal tibial fractures were evaluated by the Baird scores,giving 5 excellent and one good cases.Follow-ups found no complications like postoperative infection,loosening or breakage of implants,or bone nonunion.Conclusion Composite bridge internal fixation is a good alternative treatment for children metaphyseal fractures,because it has advantages of minimal invasion,operative simplicity,reliable fixation and limited postoperative complications.