丝线编织成型技术在儿童下肢长骨干粉碎性骨折中的应用探讨

Evaluation of braiding osteogenesis technique in comminuted fractures of the long diaphysis of the lower limbs in children

目的探讨丝线编织成型技术在儿童下肢长骨干粉碎性骨折治疗中的初步临床应用效果。方法收集本院2015年6月至2018年6月儿童下肢长骨干粉碎性骨折病例,共8例,其中男5例,女3例,年龄5~11岁,平均(8.0±1.9)岁,其中粉碎性骨折位于股骨干3例,胫腓骨干3例,股骨干加胫腓骨1例,股骨近端病理性骨折1例。其中2例为GaustioⅡ型开放性骨折。8例患儿术中均采取切开复位,结合钢板、克氏针内固定或外固定架固定,切开复位过程中均采取丝线编织成型技术,将骨折端或游离骨块聚拢恢复管状结构。定期随访复查X线片了解骨痂生长及骨折塑性情况,收集相关并发症,并按照Johner-Wruhs评分对骨折临近的膝踝关节功能进行评价。结果8例患儿行切开复位结合丝线编织成型技术,通过内固定或外固定均获得可接受的对位对线,开放性外伤接受早期清创,病理性骨折同期行病灶刮除加植骨。随访时间0.5~2.5年,平均(1.5±0.6)年,X线判定骨折愈合时间为1.5~3.5个月,平均(2.4±0.7)个月。临床效果评价,优为5例,良为2例,中为1例,优良率为87.5%。并发症统计,1例胫腓骨干骨折出现切口感染,经二期清创换药痊愈,无其他严重并发症。结论丝线编织成型技术在儿童下肢长骨干粉碎性骨折治疗中有一定的临床应用价值,该技术适用于长骨干多段粉碎性骨折,存在骨髓腔塌陷或者开放性损伤,且未发现骨折愈合过程中出现与丝线相关的并发症。

Objective To explore the clinical application effect of braiding osteogenesis technique in the treatment of comminuted fractures of the long diaphysis of the lower limbs in children.Methods A total of 8 cases of comminuted fractures of the long diaphysis of lower limbs of children in this hospital from June 2015 to June 2018 were collected,including 5 males and 3 females,with an average age of(8.0±1.9)years old(5 to 11 years).The patients included 3 cases of femoral comminuted fractures,3 cases of tibiofibular shaft comminuted fractures,1 case of femoral and tibial fibular comminuted fracture,and 1 case of proximal femur with pathologic fracture.Two of them were GaustioⅡtype open fractures.In this group,open reduction combined with plate,internal fixation with kirschner wire or external fixation with external fixator were adopted.In the process of open reduction,the braiding osteogenesis technique was applied,and the fracture end or free bone pieces were gathered together to restore the tubular structure.X-ray examination was conducted regularly during follow-up to understand the growth of callus and fracture plasticity,Any related complications were collected,and the Johner-Wruhs score was used to evaluated the function of adjacent joints.Results All 8 children obtained an acceptable alignment through open reduction and braiding osteogenesis technique with internal fixation or external fixation.Open trauma received early debridement,and pathological fractures were treated with lesion curettage and bone grafting.The follow-up time was 0.5-2.5 years with an average of(1.5±0.6)years,and the fracture healing time was 1.5-3.5 months with an average of(2.4±0.7)months according to a series of X-ray films.The clinical effect was evaluated as excellent in 5 cases,good in 2 cases,and medium in 1 case,with an excellent and good rate of 87.5%.As for complications,one case of tibial fracture had incision infection,but recovered after the second phase of debridement dressing.The were no other serious complications.Conclusion The technique of braiding osteogenesis has some clinical application value in the treatment of comminuted fractures in children.This technique is suitable for comminuted fractures of long diaphysis with collapse or open injury of bone marrow cavity.In this study,no silk-thread related complications were found during fracture healing process.