切开复位金属螺钉固定与可吸收螺钉固定治疗青少年胫骨远端骨骺骨折的治疗结果比较

Metallic screw fixation versus absorbable screw fixation after open reduction in treatment of distal tibial epiphyseal fractures in adolescents

目的比较切开复位金属螺钉固定与可吸收螺钉固定治疗青少年胫骨远端骨骺骨折的治疗结果。方法回顾性分析2013年1月至2020年12月中国医科大学附属盛京医院小儿骨科收治的82例闭合性胫骨远端骨骺损伤患者资料。男61例,女21例;年龄范围值为8~15岁;左侧39例,右侧43例。骨折Salter-Harris分型:Ⅱ型25例,Ⅲ型8例,Ⅳ型49例。根据内固定方式不同分为2组:A组42例(采用切开复位金属螺钉固定)和B组40例(采用切开复位可吸收螺钉固定)。记录并比较两组患者术前资料、手术时间、总治疗费用及随访期间并发症发生情况。末次随访时摄双侧踝关节正、侧位X线片对两组胫骨远端骨骺损伤患儿进行影像学评估,并根据美国足踝外科协会(AOFAS)踝-后足评分评价踝关节功能。结果A组与B组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。A组患者术后随访18.0(16.0,21.3)个月,B组患者术后随访16.0(13.0,20.0)个月。A组总治疗费用[2.7(2.5,3.3)万元]显著多于B组[2.3(1.9,2.7)万元],差异有统计学意义(P<0.05)。A组与B组手术时间分别为(112.4±34.3)、(101.0±41.1)min,差异无统计学意义(P>0.05)。末次随访时A组患侧和健侧的胫骨远端外侧角分别为89.5(88.0,91.0)°、89.7°±1.8°,B组患侧和健侧的胫骨远端外侧角分别为90.0(88.3,90.8)°、89.5°±1.8°;A组患侧和健侧的胫骨远端前角分别为81.9°±1.8°、81.8±1.5°,B组患侧和健侧的胫骨远端前角分别为82.0(81.0,83.0)°、82.1°±2.2°,以上项目患侧与健侧组内和组间比较差异均无统计学意义(P>0.05)。A组与B组术后浅表感染发生率[11.9%(5/42)vs.0%(0/40)]比较差异有统计学意义(P<0.05)。两组骨骺早闭发生率[11.9%(5/42)vs.5.0%(2/40)]比较差异无统计学意义(P>0.05)。末次随访时A组AOFAS的踝-后足评分[(90.6±4.9)分]与B组[(92.1±4.6)分]比较差异无统计学意义(P>0.05)。结论与金属螺钉相比,可吸收螺钉治疗青少年胫骨远端骨骺骨折在固定效果、功能和影像学方面疗效相当,骨骺早闭风险无明显增加,无需二次手术取出,同时可减少手术时间和总治疗费用。

Objective To compare the efficacy between metallic screw fixation and absorbable screw fixation after open reduction in the treatment of adolescent distal tibial epiphyseal fractures.Methods A retrospective study was conducted to analyze the data of 82 patients with closed distal tibial epiphyseal fracture who had been admitted to Department of Pediatric Orthopedics,Shengjing Hospital Affiliated to China Medical University from January 2013 to December 2020.There were 61 males and 21 females(aged from 8 to 15 years),and 39 left sides and 43 right sides.The Salter-Harris classification:typeⅡin 25 cases,typeⅢin 8 cases,and typeⅣin 49 cases.They were divided into 2 groups according to different internal fixation methods.Group A(42 cases)was subjected to open reduction and metallic screw fixation and group B(40 cases)to open reduction and absorbable screw fixation.Preoperative data,operation time,total treatment cost and complications during follow-up were recorded and compared between the 2 groups.In both groups at the last follow-up,anteroposterior and lateral ankle radiographs were taken for radiographic evaluation of the injury to the distal tibial epiphysis and the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was used to assess the ankle function.Results The 2 groups were comparable because there were no significant differences in all their preoperative demographic data(P>0.05).Group A was followed up for 18.0(16.0,21.3)months while group B for 16.0(13.0,20.0)months.The treatment cost for group A[27,000(25,000,33,000)Yuan]was significantly higher than that for group B[23,000(19,000,27,000)Yuan](P<0.05).The operation time was(112.4±34.3)min for group A and(101.0±41.1)min for group B,showing no significant difference(P>0.05).The lateral distal tibial angle was 89.5(88.0,91.0)°on the affected side and 89.7°±1.8°on the unaffected sides in group A;it was 90.0(88.3,90.8)°on the affected side and 89.5°±1.8°on the unaffected side in group B.The anterior distal tibial angle was 81.9°±1.8°on the affected side and 81.8°±1.5°on the unaffected side in group A;it was 82.0(81.0,83.0)°on the affected side and 82.1°±2.2°on the unaffected side in group B.There was no significant difference in the above comparisons at the last follow-up in radiographic evaluation of the distal ankle joint between the affected and the unaffected sides in either group or between groups(P>0.05).There was a significant difference between the 2 groups in the rate of superficial skin infection[11.9%(5/42)versus 0%(0/40)](P<0.05),but there was no significant difference in the incidence of premature physeal closure between the 2 groups[11.9%(5/42)versus 5.0%(2/40)](P>0.05).The last follow-up revealed no significant difference in the AOFAS ankle-hindfoot score between group A[(90.6±4.9)points]and group B[(92.1±4.6)points](P>0.05).Conclusions In the treatment of adolescent distal tibial epiphyseal fractures,compared with metallic screw fixation,absorbable screw fixation may lead to comparable efficacy in fixation,functional recovery and imaging evaluation,but no increased risk of premature physeal closure.Moreover,it spares the need for secondary surgical removal,and reduces operation time and treatment cost.