大龄儿童距骨颈骨折的治疗分析

目的 总结大龄儿童距骨颈骨折的诊治经验,为正确治疗大龄儿童距骨颈骨折提供参考和依据.方法 回顾分析2001年6月至2009年11月收治的10例大龄儿童距骨颈骨折的临床资料,其中男7例,女3例；年龄8～16岁,平均13.4岁；左侧4例,右侧6例.骨折根据改良Hawkins分型:Ⅰ型骨折3例,Ⅱ型骨折5例,Ⅲ型骨折2例.HawkinsⅠ型骨折采取保守治疗,非负重石膏外固定6～8周,HawkinsⅡ、Ⅲ型骨折均采取切开复位内固定.结果 随访15～68个月,平均23.5个月,随访时骨折均获愈合,无延迟愈合及骨不连.采用Hawkins评分:优5例,良4例,中1例,优良率为90.0％.发生切口皮缘表浅坏死1例,距骨体缺血性坏死2例,采用保守治疗后症状缓解.结论 恢复距骨的解剖关系是治疗儿童距骨颈骨折的关键,可靠的固定有利于早期功能锻炼,从而获得良好的治疗效果.其治疗方式的选择应根据患儿的个体状况、骨折类型等综合考虑:Hawkins Ⅰ型骨折可采取保守治疗,HawkinsⅡ、Ⅲ型骨折宜行切开复位内固定.

Treatment of talar neck fractures in older children

Objective To summarize the experience of diagnosis and treatment of talar neck fractures in older children,aiming to provide a reliable and predictable program.Methods The clinical data of patients suffering from tallar neck fractures (June 2001-November 2009) were retrospectively reviewed.The patients included 7 males and 3 females with an average age of 13.4 years (ranging from 8 to 16 years old),among which 4 children were left talar neck fractures and 6 were right.According to the modified Hawkins classification,3 cases were type Ⅰ,5 were type Ⅱ,and 2 were Type Ⅲ.All type Ⅰ patients underwent conservative treatment with 6-8 weeks of non-weight bearing plaster external fixation,type Ⅱ and Ⅲ patients were treated with open reduction and internal fixation (ORIF).Results All patients were followed up for 23.5 months averagely (ranging 15 to 68 M),and they healed completely during follow-up period.Referring to the Hawkins scoring system,5 cases were assessed as excellent,4 as good,and 1 as fair,which means 90 percent of patients achieve satisfactory efficacy.1 case was complicated with superficial skin flap necrosis and 2 cases were complicated with talar body avascular necrosis,and recovered after further conservative treatment.Conclusions Anatomical reconstruction is essential for talar neck fractures in children; better fixation will contribute greatly to the functional recovery and mobilization in early phase of healing.Selection of therapeutic approach for pediatric talar neck fracture should refer to the individual status and fracture type.Our experience suggests that of Hawkins type Ⅰ fracture should be treated with conservative treatment,while type Ⅱ and Ⅲ should be treated with ORIF.