儿童胫骨结节骨骺骨折

Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.     

复合软组织手术对儿童习惯性髌骨脱位髌股关节适应性的影响

目的 研究复合软组织手术治疗不同年龄段儿童习惯性髌骨脱位后,髌股关节适应性的变化情况.方法 回顾性分析2000至2007年收治的习惯性髌骨脱位患儿73例.男24例,女49例;平均年龄7.1岁(3～15岁);单侧47例,双侧26例.按照年龄分为A、B两组:A组年龄3～8岁(包括8岁),24例(30膝);B组年龄8～15岁,49例(69膝).复合软组织手术包括膝关节外侧充分松解、内侧紧缩、髌腱半腱上点移位(Roux-Goldthwait手术)和股内侧肌止点下移术.术前及随访中分别行髌骨轴位和侧位X线检查,测量股骨滑车角、髌骨高度、髌骨-滑车适配角及髌骨倾斜角(Laurin角)的变化情况,以评价髌股关节适应性.结果 73例患儿均获随访,平均随访38个月(25～98个月).末次随访时髌骨脱位均无复发,其中2例发生髌骨内侧脱位.股骨滑车角:A组由术前的150.1°±5.1°改善为144.3°±6.0°,手术前后差异有统计学意义(P＜0.05);B组手术前后差异无统计学意义(P＞0.05).其余测量指标在两组均无显著变化.结论 复合软组织手术对儿童习惯性髌骨脱位髌股关节的塑型有影响,对于手术年龄在8岁以下儿童可以明显促进股骨髁的发育,降低股骨滑车角,改善髌股关节适应性;8岁以上儿童在随访期内股骨滑车角的变化不显著,髌股关节适应性改变不明显.     

儿童胫骨结节骨骺骨折

Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.     

不同复位质量的儿童肱骨髁上骨折对闭合穿针固定的要求

目的 探讨不同复位质量的儿童肱骨髁上骨折闭合穿针固定后再移位原因并提出相应的预防措施.方法 回顾2005年1月～2009年9月,采用闭合复位经皮穿针内固定治疗的603例Ⅲ型儿童肱骨髁上骨折患者,年龄1～14岁（平均7岁）.全部患者术中均获得解剖复位或功能复位.受伤至手术的时间：1周以内者507例,解剖复位435例,功能复位72例;超过1周者96例,解剖复位50例,功能复位46例.分别于术后3 d、10 d、3周或4周拍片复查.骨折位置与术中位置不符者归为再移位病例,共36例.按照Sankar分类,穿针失误26例,发生再移位17例,无穿针失误577例,发生再移位19例.107例无穿针失误的功能复位2枚穿针38例,再移位9例;3枚穿针69例,再移位3例.对于上述分类统计的数据采用2检验进行统计学分析,P＜0.05被认为具有统计学差异.结果 伤后1周内治疗者解剖复位率（86%）明显高于1周后治疗者（52%）.穿针失误的再移位率（65%）明显高于无穿针失误者（3.3%）;对于无穿针失误的功能复位者,2枚针的再移位率（24%）明显高于3枚针（4.3%）,差异均具有统计学意义.结论 对于儿童Ⅲ型肱骨髁上骨折应尽早闭合复位经皮穿针内固定,这样有利于实现解剖复位,增加内在稳定性.对于解剖复位者,避免穿针失误,即可获得骨折位置的稳定.而对于功能复位者,3枚针固定的稳定性优于2枚针.     

先天性马蹄内翻足治疗:历史、现状与未来

正先天性马蹄内翻足是肌肉骨骼系统常见的先天性疾患之一,畸形始于胚胎期,生后即可发现,表现典型,容易确立诊断。但是,对于该病的治疗却经历了一个漫长的探索过程,甚至贯穿了整个骨科的发展史,至今仍有许多问题没有得到满意的解决方案。认真回顾马蹄内翻足的治疗历史,我们得到一个令人意外的发现:相同的错误被一次又一次地重复着!为此,特对本病的治疗做系统回顾,以史为鉴,以期指导未来的工作。一、历史回顾关于马蹄内翻足的文字记载最早见于公元前400年Hippocrates的描述,他认为致病因素为机械压迫,     

胫后肌与腓骨短肌平衡前移术在儿童高弓内翻足治疗中的应用

目的 介绍胫后肌、腓骨短肌平衡前移术在儿童高弓内翻足治疗中的应用,总结其操作方法、适应证及临床疗效.方法 以北京积水潭医院小儿骨科2016—2018年收治的21例高弓内翻足患儿为研究对象,共25足;手术时患儿年龄(11.10±2.08)岁,随访(4.37±1.14)年.通过足部软组织松解、截骨治疗(骰骨、内侧楔骨或中跗...     

儿童胫骨结节骨骺骨折

Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.     

儿童胫骨结节骨骺骨折

Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.     

经皮跟腱切断治疗马蹄内翻足的术中疗效观察

目的 Ponseti方法是目前低龄马蹄内翻足的主要治疗手段,固定畸形矫正主要通过前两个阶段完成,即石膏矫形和腱切断,其中腱切断用来治疗踝关节跖屈畸形。本研究旨在明确此手术的矫正能力,并通过不同月龄、不同畸形程度间的比较,评估此手术的有效性。方法采集北京积水潭医院小儿骨科2015年6月1日至2017年6月1日间所有进行腱切断手术的先天性马蹄内翻足病例资料,收集手术矫正相关数据,并按照两种不同的方式进行分组。第一种按月龄分组,旨在观察随月龄增长,手术效果是否存在不同或有何变化趋势;第二种按原始畸形严重程度分组,旨在观察严重畸形与轻中度畸形的足是否存在手术矫正效果的差异。畸形程度分组采用Pirani评分系统,将≥5分列为重度畸形组,5分列为轻度畸形组,分别比较不同月龄组间、不同畸形程度组间的差别。结果共有173例符合入组标准的患者进入本研究,其中68例行双侧手术(共136侧),105例行单侧手术(共105侧),合计行经皮跟腱切断术241侧。按月龄共分为9组,不同月龄组间手术效果存在差异(F=9.187,P 0.001)。采用LSD法进行多重比较,3至6月龄间变化幅度较小,组间差异无统计学意义;而其余各组间差异存在统计学意义,根据趋势检验结果证实,越早治疗者手术效果越好,即采用相同的腱切断手术,低月龄患者可获得更大的矫正角度。经分析发现,原始畸形的轻重程度并不会影响经皮跟腱切断这一手术的有效范围(t=0.395,P=0.693)。腱切断的手术有效范围为(35.32±8.283)°。结论腱切断的有效范围在35°左右,且与月龄密切相关,1月龄组在40°左右,7月龄以上组在30°以下;随月龄增加,手术矫正范围下降。跟腱切断手术的矫正能力与原始畸形的轻重程度无关。     

儿童胫骨结节骨骺骨折

目的 探讨儿童胫骨结节骨骺骨折的特点、治疗及预后.方法 1995年1月至2007年12月,胫骨结节骨骺骨折患儿28例,其中资料完整者25例,男23例,女2例;年龄12～16岁.平均13.5岁;左侧10例,右侧15例,均为单侧受累.损伤方式:打篮球时受伤10例,跳跃时受伤7例,踢足球时受伤8例.根据Ogden分型标准,1A型1例,1B型4例,2A型5例,2B型7例,3A型4例,3B型4例.除1例1A型患儿骨折采用闭合复位长腿石膏前后托固定外,余24例均采用切开复位拉力螺钉内固定.结果 所有患儿均获得随访,随访时间14个月～7年,平均43个月.术后3个月患儿膝关节活动范围0°～140°,术后6个月恢复伤前运动水平.按照Mosier临床评价标准,结果均为优.所有病例手术切口均一期愈合,均未发生胫前间室综合征.骨折愈合时间2～5个月,平均3个月,伸膝装置序列正常,无一例患儿发生切口感染、内固定物失效或肢体畸形.结论 儿童胫骨结节骨骺骨折是一种不常见的特殊类型的骺损伤.在伸膝装置突然加速或减速的运动中,当髌韧带的牵拉力超过胫骨结节骨骺、周围软骨膜以及邻近骨膜的结合力时,就会发生胫骨结节的骨骺骨折.该骨折多见于13～16岁的男性患儿,单侧发病为主;可采用拉力螺钉内固定治疗,术后患儿膝关节功能正常.