儿童踝关节Dias-Tachdjian分型旋后外旋Ⅱ度损伤腓骨骨折治疗方案探讨

Treatment of the fibular fracture in Degree Ⅱ ankle supination-external rotation injury of the Dias-Tachdjian classification in children

目的探究儿童踝关节Dias-Tachdjian分型旋后外旋Ⅱ度损伤腓骨骨折内固定的必要性。方法回顾性分析自2015年1月至2021年10月潍坊市人民医院创伤骨科和天津大学天津医院小儿骨科收治的69例Dias-Tachdjian分型旋后外旋Ⅱ度损伤的儿童踝关节骨折患者资料。男41例,女28例;年龄(10.1±1.4)岁;左侧37例,右侧32例;根据是否进行腓骨内固定分为2组:A组21例(术中解剖复位胫骨远端骨折后内固定腓骨骨折),B组48例(术中解剖复位胫骨远端骨折后不内固定腓骨骨折)。记录并比较两组患者术前一般资料、手术时间、手术费用。末次随访时行双下肢全长及踝关节正、侧位X线片,测量患侧胫骨远端外侧角(LDTA)、患侧胫骨远端前倾角(ADTA)和双侧踝关节胫距角差值,同时根据美国足踝外科协会(AOFAS)踝-后足评分评定踝关节功能,并记录骨骺早闭发生情况。结果两组患儿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。所有患儿术后获(19.5±4.1)个月随访。末次随访时A、B组患儿患侧LDTA分别为89.6°(87.9°,90.5°)、88.6°±1.9°,患侧ADTA分别为80.9°(79.0°,81.4°)、80.0°(78.6°,81.2°),双侧踝关节胫距角差值分别为1.1°±0.5°、1.2°±0.5,AOFAS踝-后足评分分别为(89.5±5.2)、89.0(87.0,92.0)分,以上项目组间比较差异均无统计学意义(P>0.05);术后A、B组的骨骺早闭发生率分别为14.3%(3/21)和14.6%(7/48),差异无统计学意义(P>0.05)。结论儿童踝关节Dias-Tachdjian分型旋后外旋Ⅱ度损伤患儿腓骨骨折内固定与否对踝关节影像学角度和功能均无明显影响;踝关节旋后外旋Ⅱ度损伤患儿胫骨远端得到解剖复位后,腓骨骨折可不行内固定治疗,能够减少手术创伤,缩短手术时间,减少手术费用。

Objective To investigate the necessity of internal fixation of the fibular fracture in the treatment of degree Ⅱ ankle supination-external rotation injury by the Dias-Tachdjian classification in children.Methods A retrospective study was conducted to analyze the data of 69 children with ankle fracture(degree Ⅱ ankle supination-external rotation injury by the Dias-Tachdjian classification)who had been treated at Department of Orthopedic Trauma,The People's Hospital of Weifang and Department of Pediatric Orthopedics,Tianjin Hospital from January 2015 to October 2021.There were 41 males and 28 females with an age of(10.1±1.4)years,and 37 left and 32 right sides affected.The patients were divided into 2 groups according to whether internal fixation of the fibular fracture was performed.Group A consisted of 21 cases with fibular internal fixation and group B of 48 cases without fibular internal fixation.The preoperative data,operation time and operation expenses were recorded and compared between the 2 groups.At the last follow-up,the anteroposterior and lateral radiographs of bilateral full length lower limbs and ankle joints were taken;the lateral distal tibial angle(LDTA)and the anterior distal tibial angle(ADTA)on the affected side,and the disparity between bilateral ankle tibiotalar angles were measured;ankle function was assessed according to the ankle-hindfoot score of American Association of Foot and Ankle Surgery(AOFAS);the occurrence of premature physeal closure(PPC)was recorded.Results There was no significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).All patients were followed up for(19.5±4.1)months.At the last follow-up,the LDTA on the affected side was 89.6°(87.9°,90.5°)in group A and 88.6°±1.9°in group B;the ADTA on the affected side was 80.9°(79.0°,81.4°)in group A and 80.0°(78.6°,81.2°)in group B;the disparity between bilateral ankle tibiotalar angles was 1.1°±0.5°in group A and 1.2°±0.5°in group B;the AOFAS ankle-hindfoot score was(89.5±5.2)points in group A and 89.0(87.0,92.0)points in group B.There was no statistically significant difference between the 2 groups in the above items(P>0.05).The incidence of PPC was,respectively,14.3%(3/21)and 14.6%(7/48)in groups A and B,showing no statistically significant difference(P>0.05).Conclusions In the treatment of degreeⅡankle supination-external rotation injury in children,internal fixation of the fibular fracture has no significant effect on the imaging angles or the function of the ankle joint.After anatomic reduction of the distal tibia,the fibular fracture can be treated without internal fixation to reduce operational trauma,shorten operation time and reduce operation expenses.