青少年胫骨结节撕脱性骨折的治疗

目的 对青少年胫骨结节撕脱性骨折临床治疗结果进行分析,并回顾以往文献报告,总结该病的治疗及预后.方法 回顾性分析2003年1月至2008年6月间9例采用非手术和手术方法治疗的胫骨结节撕脱性骨折患儿,均为男性,年龄12岁10个月～16岁3个月,平均年龄14岁7个月;体重50～89 kg,平均66 kg;身高165～180 cm,平均173 cm.均是在运动中跳起或着地时受伤,篮球6例,足球1例,跳高1例,跨栏1例.其中1例有Osgood-Schlatter病,2例受伤前有明显的胫骨结节区疼痛病史.髌韧带撕脱2例,无关节内损伤病例.按照Ogden和Ryu & Debenham改良分型:Ⅰ型1例,Ⅱ型2例,Ⅲ型4例,Ⅳ型2例.非手术治疗3例,手术治疗6例.非手术组均行手法复位管型石膏固定;手术组切开复位内固定治疗,其中空心螺钉固定3例,克氏针及螺钉固定2例,可吸收螺钉固定1例,同期行关节探查3例.两组均行石膏固定6周.随访骨折愈合、关节功能及畸形情况.结果 8例患儿获得随访,1例保守治疗的患儿失随访,随访时间6个月至5年6个月,平均27.5个月.根据Mosier等的标准对患儿肢体功能进行评估,结果 均为优.2例有股四头肌萎缩,1例髌下感觉减退,无骨筋膜室综合症、膝反张、感染、关节屈曲障碍、再骨折、肢体不等长等并发症.结论 对于青少年胫骨结节撕脱性骨折非移位或轻微移位骨折可以保守治疗,但要警惕骨筋膜间室综合症发生.移位性骨折行切开复位空心螺钉内固定,同时修复撕裂的髌韧带、骨膜町以达到满意的疗效.

Tibial tubercle avulsion fracture in adolescents: 9 cases and review of the literature

Objective To review the clinical outcome of tibial tubercle avulsion fracture in adolescents.Methods This was a retrospective analysis of a consecutive series of 9 children with tibial tubercle avulsion fracture managed in our institution between January 2003 and June 2008.All patients were boys,with an average age of 14.6 years(range 12.8-16.3).The average weight was 66 kg (range 50-89)and the average height was 173cm (range 165-180).The avulsion occurred after a jump or on landing 8 children-The fracture occurred during basketball (n=6),Soccer (n=1),High jump (n=1),hurdle jump (n=1).One was diagnosed with Osgood-Schlatter disease and two patients presented symptomatic ipsilateral or contralateral anterior tibial apophysitis before the accidents.There were three patellar ligament avulsion and no meniscal injury.According to the Ogden's and Ryu and Debenham's modified classification system,there were 1 type I (11%);2 type Ⅱ (22%);4 type Ⅲ(44%),2 type Ⅳ (22%) injuries.Three patients had close reduction under anesthesia and cvlinder cast immobilization.Six patients underwent open reduction and internal fixation,including 3 cancellous screws,2 Kirschner wires and screws,and 1 absorbable screws.Three patients underwent knee joint exploration.Cast immobilization was maintained for six weeks in both groups.The functional outcome was assessed at last follow-up.Results One patient was lost during follow-up.Eight patients were followed up for a mean of 27.5 months (range 6-66).The functional outcome was excellent in all patients according to the Mosier's scoring system for the motion function.Two of 8 patients had quadriceps atrophy,one had infrapatellar hypoesthesia.There were no compartment syndrome,deformity ol knee joint,nonunion,genu recurvatum,infection,refracture or leg length discrepancy.Conclusions Tibial tubercle avulsion with minimal displacement can be treated conservatively.The displaced fracture generally require open anatomic reduction and internal fixation.The outcome is generally good.