青少年胫骨远端三平面骨折的个性化治疗

Personalized treatment of triplane fractures of the distal tibia in adolescents

目的 探讨依据不同骨折类型制订青少年胫骨远端三平面骨折个性化治疗方案的临床疗效。方法 选取唐山市第二医院2016年1月至2021年12月收治的青少年胫骨远端三平面骨折患儿57例作为研究对象,所有纳入病例术前依据骨折分型制订个性化的治疗方案,采用闭合或切开复位内固定。依据美国足踝外科协会(American Orthopaedic Foot and Ankle Societ,AOFAS)评分标准对治疗结果予以评估。结果 闭合复位内固定35例,切开复位内固定22例,同时固定腓骨骨折11例,固定下胫腓联合损伤8例。53例患儿获得随访,随访时间为16~39个月。随访时的AOFAS评分:优44例,良5例,中2例,差2例,优良率为92.45%。结论 胫骨远端三平面骨折是青少年时期特有的一种复杂的骨骺损伤,术前依据骨折分型制订个性化的治疗方案,合理设计手术切口,可以缩短手术时间、减少术中出血量、最大程度地保证骨折解剖复位,踝关节可获得最佳功能,同时为更多的骨科医生提供可供参考的治疗方案。

Objective To investigate the clinical effect of personalized treatment plan for triplane fracture of distal tibia in adolescents according to different fracture types.Methods Fifty-seven children with triplane fracture of the distal tibia were selected from Tangshan Second Hospital from January 2016 to December 2021 as the subjects of study.All the patients were included in the study.A personalized treatment plan was formulated according to the fracture classification before operation,and closed or open reduction and internal fixation were used.The treatment results were evaluated according to the American Orthopaedic Foot and Ankle Society(AOFAS)scoring criteria.Results There were 35 cases of closed reduction and internal fixation,22 cases of open reduction and internal fixation,11 cases of fibula fracture and 8 cases of distal tibiofibular syndesmosis injury.Fifty-three children were followed up for 16 to 39 months.Postoperative AOFAS foot score was excellent in 44 cases,good in 5 cases,moderate in 2 cases,and poor in 2 cases,with an excellent and good rate of 92.45%.Conclusions Triplane fracture of distal tibia is a unique complex epiphyseal injury in adolescence.Personalized treatment plan is made according to the fracture classification before operation.Reasonable design of surgical incision can shorten the operation time,reduce intraoperative bleeding,ensure the anatomical reduction of fracture to the greatest extent,obtain the best function of ankle joint,and provide more orthopedic surgeons with a reference treatment plan.