Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of p...Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of post-traumatic pediatric ankle varus deformity using physeal bar resection and hemi-epiphysiodesis with the assistance of two operative methods.Forty-five patients presenting with a distal tibial medial physeal bridge as well as ankle varus deformity following traumatic ankle physeal injury between 2009 and 2017 were followed.These patients were treated w让h physeal bar resection and hemi-epiphysiodesis,with the assistance of either fluoroscopy (10 cases) or intraoperative three-dimensional navigation (35 cases).Of the 45 cases,the median age was 9.0 years (range:3-14 years) with 28 male and 17 female patients.The median of pre-operation ankle varus angle was 20 degrees (IQR 15-25) and 5 degrees (IQR 0-20) at the time of final follow up,representing a statistically significant difference (P<0.05).No differences were observed with regards to age,gender,and surgical history between effective group and ineffective group (P>0.05).The median of pre-operative ankle varus angles of the navigation and fluoroscopy groups were both 20 degrees (P>0.05).The median correction angle of the navigation and fluoroscopy groups was 10 and 15 degrees,respectively (P>0.05).Our results indicate that physeal bar resection and hemiepiphysiodesis are effective treatments for correcting ankle varus deformity due to traumatic medial physeal arrest of the distal tibia.We observe no difference in outcome between fluoroscopy group and three-dimensional navigation group during the procedures.展开更多
BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop ...BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.展开更多
目的分析骨骺牵开保骺术在儿童股骨骨肉瘤保肢术中的疗效及应用价值。方法 2007年1月-2011年1月,收治6例股骨远端骨肉瘤患儿。男4例,女2例;年龄9～14岁,平均11.4岁。病程1～9个月,平均4.8个月。术前经穿刺或切开活检证实为骨肉瘤,其中...目的分析骨骺牵开保骺术在儿童股骨骨肉瘤保肢术中的疗效及应用价值。方法 2007年1月-2011年1月,收治6例股骨远端骨肉瘤患儿。男4例,女2例;年龄9～14岁,平均11.4岁。病程1～9个月,平均4.8个月。术前经穿刺或切开活检证实为骨肉瘤,其中成骨型骨肉瘤1例,软骨母细胞型骨肉瘤1例,骨母细胞型骨肉瘤1例,未明确细胞分类的骨肉瘤3例。根据Enneking提出的外科分期系统,其中ⅡA期1例,ⅡB期5例。术前采用新辅助化疗2个周期;首先行Ca adell骨骺牵开保骺术,牵开时间4～7 d,平均5.7 d;骨骺牵开保骺术完成1～2 d后行骨肿瘤切除,采用大段同种异体骨移植重建;术后进一步化疗并定期随访了解骨折愈合、下肢发育及局部和全身并发症等情况,并根据美国肌肉骨骼肿瘤学会(MSTS)评分系统评分及双膝关节活动度(range of motion,ROM)进行功能评定。结果术后发生切口浅表感染1例,经换药治疗后愈合;其余患儿切口均Ⅰ期愈合。6例均获随访,随访时间1～5年,平均2.5年;无明显肢体肿胀及疼痛等症状,未发生同种异体骨排斥反应及内固定物松动、断裂等。术后随访无肿瘤转移及局部复发等并发症发生。术后6～9个月干骺端骨性愈合5例,14个月1例;骨干部位均发生延迟愈合,术后12～48个月骨折端均有不同程度骨痂形成,但骨折线仍清晰可见。末次随访时患肢短缩1～3 cm 4例,3～5 cm 2例;发生代偿性脊柱侧弯3例,行走明显跛行2例;MSTS评分为(27.20±1.92)分,与术前(19.60±2.74)分比较差异有统计学意义(t=—4.12,P=0.00);患侧膝关节ROM为(127.00±17.89)°,与术前(109.00±12.45)°比较差异无统计学意义(t=—1.84,P=0.10),与健侧膝关节ROM(126.00±9.62)°比较差异无统计学意义(t=—0.11,P=0.92)。结论骨骺牵开保骺术可应用于骨骺尚未闭合的儿童股骨骨肉瘤保肢术中,具有操作简便、临床疗效好、术后并发症少等优点。展开更多
文摘Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of post-traumatic pediatric ankle varus deformity using physeal bar resection and hemi-epiphysiodesis with the assistance of two operative methods.Forty-five patients presenting with a distal tibial medial physeal bridge as well as ankle varus deformity following traumatic ankle physeal injury between 2009 and 2017 were followed.These patients were treated w让h physeal bar resection and hemi-epiphysiodesis,with the assistance of either fluoroscopy (10 cases) or intraoperative three-dimensional navigation (35 cases).Of the 45 cases,the median age was 9.0 years (range:3-14 years) with 28 male and 17 female patients.The median of pre-operation ankle varus angle was 20 degrees (IQR 15-25) and 5 degrees (IQR 0-20) at the time of final follow up,representing a statistically significant difference (P<0.05).No differences were observed with regards to age,gender,and surgical history between effective group and ineffective group (P>0.05).The median of pre-operative ankle varus angles of the navigation and fluoroscopy groups were both 20 degrees (P>0.05).The median correction angle of the navigation and fluoroscopy groups was 10 and 15 degrees,respectively (P>0.05).Our results indicate that physeal bar resection and hemiepiphysiodesis are effective treatments for correcting ankle varus deformity due to traumatic medial physeal arrest of the distal tibia.We observe no difference in outcome between fluoroscopy group and three-dimensional navigation group during the procedures.
文摘BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.
文摘目的分析骨骺牵开保骺术在儿童股骨骨肉瘤保肢术中的疗效及应用价值。方法 2007年1月-2011年1月,收治6例股骨远端骨肉瘤患儿。男4例,女2例;年龄9～14岁,平均11.4岁。病程1～9个月,平均4.8个月。术前经穿刺或切开活检证实为骨肉瘤,其中成骨型骨肉瘤1例,软骨母细胞型骨肉瘤1例,骨母细胞型骨肉瘤1例,未明确细胞分类的骨肉瘤3例。根据Enneking提出的外科分期系统,其中ⅡA期1例,ⅡB期5例。术前采用新辅助化疗2个周期;首先行Ca adell骨骺牵开保骺术,牵开时间4～7 d,平均5.7 d;骨骺牵开保骺术完成1～2 d后行骨肿瘤切除,采用大段同种异体骨移植重建;术后进一步化疗并定期随访了解骨折愈合、下肢发育及局部和全身并发症等情况,并根据美国肌肉骨骼肿瘤学会(MSTS)评分系统评分及双膝关节活动度(range of motion,ROM)进行功能评定。结果术后发生切口浅表感染1例,经换药治疗后愈合;其余患儿切口均Ⅰ期愈合。6例均获随访,随访时间1～5年,平均2.5年;无明显肢体肿胀及疼痛等症状,未发生同种异体骨排斥反应及内固定物松动、断裂等。术后随访无肿瘤转移及局部复发等并发症发生。术后6～9个月干骺端骨性愈合5例,14个月1例;骨干部位均发生延迟愈合,术后12～48个月骨折端均有不同程度骨痂形成,但骨折线仍清晰可见。末次随访时患肢短缩1～3 cm 4例,3～5 cm 2例;发生代偿性脊柱侧弯3例,行走明显跛行2例;MSTS评分为(27.20±1.92)分,与术前(19.60±2.74)分比较差异有统计学意义(t=—4.12,P=0.00);患侧膝关节ROM为(127.00±17.89)°,与术前(109.00±12.45)°比较差异无统计学意义(t=—1.84,P=0.10),与健侧膝关节ROM(126.00±9.62)°比较差异无统计学意义(t=—0.11,P=0.92)。结论骨骺牵开保骺术可应用于骨骺尚未闭合的儿童股骨骨肉瘤保肢术中,具有操作简便、临床疗效好、术后并发症少等优点。
