撬拨复位内固定治疗儿童内踝骨折伴骨骺损伤的疗效评价

目的 探讨克氏针撬拨闭合复位空心螺钉内固定治疗儿童内踝骨折伴骨骺损伤的临床疗效。方法 回顾性分析2014年6月至2019年6月我院采用克氏针撬拨闭合复位空心螺钉内固定治疗的35例内踝骨折伴骨骺损伤的患儿病例资料。男25例,女10例,年龄5-15岁,平均(8.3±2.8)岁。左踝16例,右踝19例。按Salter-Harris骨骺损伤分型：Ⅲ型22例(包括2例Tillaux骨折),Ⅳ型 13例。手术在C型臂X线机透视下进行,取细克氏针采用撬拨闭合复位空心螺钉内固定,记录双侧小腿的长度、手术时长、手术过程中的出血量、随访的时间以及手术前和手术后的踝关节AOFAS踝-后足功能评分、ASAMI评分、围手术期并发症发生情况等。结果 所有患儿均顺利完成手术,手术时间30-55min,平均(40.2±3.8)min,术中出血5-20ml,平均(12.1±2.7)ml。所有患儿均获得随访,随访18～48个月,平均(32.2±4.9)个月。健侧小腿的与患侧小腿长度差异无统计学意义(P>0.05)。随访的35例患儿AOFAS踝-后足功能评分较术前有显著的统计学差异(P<0.05),患侧足踝ASAMI评分显示：优34例,良1例,优良率100%。X线及CT检查提示所有病例在末次随访时均骨性愈合。并发症方面所有患儿均未出现术中及术后并发症,末次随访时所有患儿踝关节活动均不受限,均能参加日常活动及功能锻炼。 结论 克氏针撬拨闭合复位空心螺钉内固定术治疗儿童内踝骨折伴骨骺损伤的疗效确切,手术时间短、手术过程中出血量少、对内踝骨折块固定牢靠,值得在临床工作中进一步推广应用。

Evaluation of prying reduction and internal fixation in the treatment of medial malleolus fracture with epiphyseal injury in children

Objective: To investigate the clinical effect of Kirschner wire prying, closed reduction and cannulated screw internal fixation in the treatment of medial malleolus fracture with epiphyseal injury in children. Methods: The data of 35 children with medial malleolus fracture with epiphyseal injury treated by Kirschner wire prying, closed reduction and cannulated screw internal fixation in our hospital from June 2014 to June 2019 were analyzed retrospectively. There were 25 males and 10 females, aged 5-15 years, with an average of (8.3 ± 2.8) years. There were 16 cases of left ankle and 19 cases of right ankle. According to Salter Harris epiphyseal injury, there were 22 cases of type III (including 2 cases of Tillaux fracture) and 13 cases of type IV. The operation was performed under the perspective of C-arm X-ray machine. The fine Kirschner wire was taken and fixed with prying closed reduction hollow screw. The length of bilateral lower legs, operation time, amount of bleeding during operation, follow-up time, ankle AOFAS ankle hindfoot function score, Asami score and perioperative complications before and after operation were recorded. Results: All children successfully completed the operation. The operation time was 30-55 min, with an average of (40.2 ± 3.8) min. The intraoperative bleeding was 5-20 ml, with an average of (12.1 ± 2.7) ml. All children were followed up for 18 ~ 48 months, with an average of (32.2 ± 4.9) months. There was no significant difference in leg length between healthy side and affected side (P > 0.05). The AOFAS ankle hindfoot function score of 35 children followed up was significantly different from that before operation (P < 0.05). The Asami score of affected ankle showed that 34 cases were excellent, 1 case was good, and the excellent and good rate was 100%. X-ray and CT examination showed that all cases had bone healing at the last follow-up. In terms of complications, all children had no intraoperative and postoperative complications. At the last follow-up, all children had no limited ankle movement and could participate in daily activities and functional exercise. Conclusion: Kirschner wire prying, closed reduction and cannulated screw internal fixation is effective in the treatment of medial malleolus fracture with epiphyseal injury in children. It has the advantages of short operation time, less bleeding during operation and reliable fixation of medial malleolus fracture. It is worthy of further popularization and application in clinical work.