可吸收螺钉在治疗儿童膝关节骨软骨损伤中的应用

Efficacy of absorbable screws in the treatment of cartilage injury in children’s femoral weight-bearing area

目的探讨可吸收螺钉治疗儿童股骨负重区软骨损伤的疗效。方法2016年1月至2023年11月首都医科大学附属北京积水潭医院及北京积水潭医院贵州医院小儿骨科5例股骨负重区软骨损伤患者;男2例(7岁、11岁),女3例(8岁、11岁、13岁)。采用切开清理复位骨折端,使用可吸收螺钉固定。术后检测患者的关节活动度、MRI评估骨软骨损伤愈合情况[Lysholm评分、国际膝关节文献委员会(IKDC)评分等指标]。结果1例获得1年随访、1例获6个月随访、1例获得7年随访、1例获10个月随访、1例获2年随访。术后6个月患侧膝关节活动度均与对侧一致。术后6个月MRI检查骨软骨损伤均愈合,没有全层关节软骨丢失的区域,Lysholm评分、IKDC评分较术前明显提高;但4例出现不同程度软骨损伤应力处软骨下骨部分塌陷。术后3例出现膝关节外翻。结论可吸收螺钉内固定治疗儿童关节内骨软骨骨折能获得满意临床疗效。即使骨软骨损伤时间较长,仍有必要进行骨软骨回植。大面积关节内软骨下骨骨折术后可能出现一定程度软骨下骨塌陷。

Objective To investigate the efficacy of absorbable screws in the treatment of cartilage injury in children’s femoral weight-bearing area.Methods From January 2016 to November 2023,5 patients with cartilage injury in the weight-bearing area of the femur were treated in Department of Pediatric Orthopedics,Beijing Jishuitan Hospital,Capital Medical University and Guizhou Hospital of Beijing Jishuitan Hospital.There were 2 males(7 years old,11 years old)and 3 females(8 years old,11 years old,13 years old).The operation was performed by open reduction and reduction of the fracture end and fixation with absorbable screws.The range of motion,MRI evaluation of osteochondral injury healing,clinical function[Lysholm score,International Knee Documentation Committee(IKDC)score]were evaluated after operation.Results One D0I:10.195482024.04.007 patient was followed up for 1 year,one patient was followed up for 6-months,one patient was followed up for 7 years,one patient was followed up for 10 months,one patient was followed up for 2 years.The range of motion of the affected knee joint was consistent with that of the contralateral knee joint at 6 months after operation.At 6 months after operation,MRI examination showed that the osteochondral injury healed,and there was no area of full-thickness articular cartilage loss.The Lysholm score and IKDC score were significantly higher than those before operation,but 4 cases had partial collapse of subchondral bone at different degrees of cartilage injury.Knee valgus occurred in 3 cases after operation.Conclusion Absorbable screw internal fixation for the treatment of intra-articular osteochondral fractures in children can achieve satisfactory clinical efficacy,even if the osteochondral injury time is longer.It is still necessary to carry out osteochondral replantation.A certain degree of subchondral bone collapse may occur after a large area of intra-articular subchondral bone fracture.