单臂外固定架治疗儿童胫腓骨远端骨折

目的探讨单臂外固定器固定在儿童胫腓骨远端骨折治疗中的可行性及其并发症的防治,提高对儿童该类骨折的治疗水平。方法采用单臂外固定器固定治疗儿童胫骨或胫腓骨远端骨折23例,其中男性17例,女性6例;年龄2～13岁,平均年龄5岁7个月。开放性骨折8例。结果随访2～4年。23例均未见骨折不愈合及畸形愈合。按照Paley骨折愈合标准评分:优13例,良7例,中3例;优良率87%。其中发生延迟愈合5例,6例有针道感染征象,5例有螺钉部分松动,4例行超踝关节固定患儿术后踝关节功能受限,恢复较差。结论采用单臂外固定器固定治疗儿童胫腓骨远端骨折是一种安全、简便的固定方法,软组织损伤轻,骨折端血运破坏少,骨折临床愈合快,并允许早期关节活动及负重练习,减少了关节功能障碍的发生,适用于几乎所有类型的儿童胫腓骨骨折,尤其是合并严重软组织损伤修复后需长期换药或合并血管、神经损伤者;但对于合并有严重骨质疏松、广泛皮肤病变,及因为年龄或其他因素不能配合术后管理的患儿应慎用。

Treatment of distal tibiofibular fractures in children

Objective To study the clinical feasibility and complication management of single-armed external fixator in treating distal tibiofibular fractures in children and to increase the treatment level for managing tibiofibular fractures.Methods Data of twenty-three children with distal tibiofibular fractures was analyzed,who had been treated with Orthofix single-armed external fixator from Mar.2005 to Feb.2009 in our hospital.There were 17 cases of male and 6 cases of female.The average age of all patients was 5.58 years.All patients aged from 2 to 13 years（mean 5.7 years）.Meanwhile,there were 8 cases of open fracture.Results All the 23 cases were followed up（ranged from 2-4 years）.There was no nonunion or deformity in all the cases.According to the Paley score standard,excellent result were observed in 13 cases,good in 7 cases,and moderate in 3 cases.The excellent and good rate was 87%.But delayed union was found in 5 cases,pin track infection in 6 cases,screw loossening in 5 cases,and limited function of ankle joint in 4 cases.Conclusion Single-armed external fixator for tibiofibular fractures in children is a relatively safe,convenient and fast therapy method.It has advantages of micro-trauma,tiny tissue damage,little influence on blood circulation at the fracture site,and firm fixation.Meanwhile,it also has the superiority of fast recovery,early weight-bearing activity,decrease of occurrence of the joint dysfunction and the other controllable complications.The good design of single-armed external fixator makes it suitable for almost all types of tibiofibular fractures in children,especially accompanied by severe soft tissue damage which need long time dress changing during the restoration period,or accompanied by vessels or nerve injury;but the single-armed external fixator is not suitable for the cases with serious osteoporosis,extensive skin lesions,and cases who cannot cooperate with postoperative management for the factors of age or other factors.