空心螺钉固定儿童胫骨远端骨骺骨折

Cannulated screw fixation of distal tibial epiphyseal fractures in children

[目的]探讨空心螺钉内固定治疗儿童胫骨远端骨骺骨折的临床疗效。[方法]回顾性分析2018年12月—2021年12月采用闭合或切开复位后空心螺钉内固定儿童胫骨远端骨骺骨折70例患者的临床资料,评价临床及影像效果。[结果] 70例患者均顺利完成手术治疗,术中未出现血管、神经损伤等并发症。平均随访时间(8.4±2.1)个月,与术前相比,术后3个月和末次随访时VAS评分均显著下降[(5.9±1.0)分,(1.3±0.3)分,(1.2±0.2)分,P<0.001],而AOFAS评分[(34.8±7.9)分,(82.7±8.9)分,(94.1±4.1)分, P<0.001]、踝关节背伸-跖屈ROM [(36.5±4.3)°,(63.8±10.4)°,(74.9±11.5)°, P<0.001]和内翻-外翻ROM [(30.7±6.9)°,(54.8±8.9)°,(65.8±9.0)°, P<0.001]。影像方面,与术前相比,术后骨折力线对合显著改善(P<0.05),mLDTA角和a ADTA角显著增加(P<0.05)。所有患者骨折均在10周左右骨性愈合。[结论]空心螺钉内固定治疗儿童胫骨远端骨骺骨折近期效果满意,是较为可靠的治疗手段。

[Objective] To investigate the clinical outcomes of cannulated screw fixation of distal tibial epiphysis fracture in children.[Methods] A retrospective study was performed on 70 children who had distal tibial epiphysis fractures fixed with cannulated screws following closed or open reduction from December 2018 to December 2021, and the clinical and imaging data were evaluated. [Results] All the70 patients were operated on successfully without complications such as vascular and nerve injury during the operation. The follow-up period lasted for(8.4±2.1) months on an average. Compared with those before operation, and the VAS score at 3 months and the last time significantly decreased [(5.9±1.0),(1.3±0.3),(1.2±0.2), P<0.001], while AOFAS score [(34.8 ±7.92),(82.7±8.9),(94.1±4.1), P<0.001], ankle dorsal-plantar flexion range of motion(ROM) [(36.5±4.3)°,(63.8±10.4)°,(74.9±11.5)°, P<0.001] and inversion-eversion ROM [(30.7±6.9)°,(54.8±8.9)°,(65.8±9.0)°, P<0.001] significantly increased. Radiographically, the fracture alignment was significantly improved after surgery compared to before surgery(P<0.05), additionally, the m LDTA angle and aADTA angle significantly improved postoperatively(P<0.05). Bony healing of the fractures was observed in all patients at about 10 weeks. [Conclusion] The cannulated screw fixation is a reliable treatment for distal tibial epiphyseal fractures in children with satisfactory short-term outcomes.