接骨药丸联合闭合复位交叉克氏针内固定治疗儿童胫骨远端骨骺损伤43例

43 Cases of Osteosynthesis Pill Combined with Closed Reduction and Crossed Kirschner Wire Internal Fixation on the Treatment of Distal Tibial Salter-Harris Type Ⅱ Epiphyseal Injury in Children

目的:观察接骨药丸联合闭合复位交叉克氏针内固定治疗儿童胫骨远端Salter-HarrisⅡ型骨骺损伤的临床疗效。方法:2017年1月至2019年6月本院小儿骨科收治的43例儿童胫骨远端Salter-HarrisⅡ型骨骺损伤患者,均为伤后立即就诊的新鲜闭合伤;其中男31例,女12例;年龄6~12岁,中位数8.5岁。左侧胫骨远端Salter-HarrisⅡ型骨骺损伤22例,右侧胫骨远端Salter-HarrisⅡ型骨骺损伤21例。其中摔伤32例,车祸伤11例。采用闭合复位交叉克氏针内固定治疗,术后给予口服接骨药丸1个月。观察患者骨折解剖复位,骨性愈合时间,无血管、神经损伤等并发症的情况。对于术后踝关节功能的恢复采用AOFAS踝-后足评分量表进行评定。结果:43例患者获随访,随访12~18个月,中位数14个月。所有患者均一次性手法整复并交叉克氏针固定成功,骨折解剖复位。所有患者均骨性愈合,愈合时间为3~5个月,中位数4个月,无血管、神经损伤等并发症,没有出现骨骺早闭和关节面不平整等后遗症。按照AOFAS踝-后足评分量表,踝关节功能评分:优35例,良6例,可2例,优良率95.3%。结论:接骨药丸结合闭合复位交叉克氏针内固定治疗儿童胫骨远端Salter-HarrisⅡ型骨骺损伤具有损伤小、固定牢固、骨折愈合好、关节功能恢复好等优点,值得临床推广应用。

Objective:To observe the clinical efficacy of osteosynthesis pill combined with closed reduction and cross kirschner wire internal fixation on the treatment of distal tibial salter-Harris Ⅱ epiphyseal injury in children.Methods:43 children with distal tibial Salter-Harris type Ⅱ epiphyseal injury from January 2017 to June 2019 were treated immediately after injury.There were 31 males and 12 females.The age ranged from 6 to 12 years old,with an average age of 8.5 years old,which concluded 22 cases of Salter-Harris type Ⅱ epiphyseal injury at the distal end of the left Tibia and 21 cases of Salter-Harris Type Ⅱ epiphyseal injury at the distal end of the right Tibia.There were 32 falls and 11 car accidents.The patients were treated with closed reduction and internal fixation with crossed kirschner wires.After operation,patients were given oral bone-setting pills for 1 month.The anatomic reduction of fracture,bone healing time,complications such as vascular and nerve injury were observed.The functional recovery of the ankle was assessed by the AOFAS ankle-foot rating scale.Results:43 patients were followed up for 12 to 18 months,with median of 14 months.All patients were successfully treated by manual reduction and cross kirschner wire fixation,and the fracture was reduced anatomically.All patients had bone healing;the healing time was 3 to 5 months;the median was 4 months.There were no vascular,nerve injury and other complications,no epiphyseal early closure and uneven joint surface sequelae.The ankle function score showed that excellent in 35 cases,good in 6 cases,fair in 2 cases and excellent and good in 95.3% according to ankle-hind foot rating scale(AOFAS).Conclusion:The combination of osteosynthesis pill with closed reduction and crossed kirschner wire internal fixation for the treatment of epiphyseal injuries of Type Ⅱ Salter-Harris in the distal tibia in children has the advantages of less damage,firm fixation,good fracture healing and good recovery of joint function,which is worthy of clinical application.