儿童跟骨关节内骨折的分型特征及手术治疗

 目的 回顾性评估儿童跟骨关节内骨折的手术治疗效果, 并总结儿童跟骨关节内骨折的特征。方法 2004年 1月至 2008年 10月, 对 8例 9足儿童闭合性跟骨关节内骨折行手术治疗, 男 7 例, 女 1例;年龄 10~15岁, 平均 13.1岁。术前通过 X线片及 CT检查对骨折情况进行评估和分型, 术后通过临床检查及 X线片随访, 临床评估使用改良 AOFAS评分。并对已发表的手术治疗儿童跟骨关节 内骨折的文献进行综合分析。结果 按照 Essex-Lopresti分型, 舌型骨折 4例 4足, 关节压缩型 5例 5 足;按照 Sanders分型, 域型 5例 5足, III型 3例 3足, 郁型 1例 1足。均获得 21~72个月随访, 平均 47.4 个月。平均骨折愈合时间为 2.8个月(2~4个月)。术前及术后 B?hler角分别平均为 5.7°和 33.1°, Gissane 角分别平均为 106.5°和 128.0°;平均改良 AOFAS评分为 65.2分(53~68分)。有 1足出现皮缘局部坏 死, 无其他并发症发生。文献综合结果, 儿童跟骨关节内骨折患者, 男性占 78.6%(48/61);Sanders域型占 53.7%(36/67), III型占 37.3%(25/67), 郁型占 9.0%(6/67);Essex-Lopresti舌型骨折占 40.5%(15/37), 关节压缩型占 59.5%(22/37)。结论 儿童闭合性跟骨关节内骨折, 通过手术治疗恢复较快且预后良好, 并发症发生率低。儿童跟骨关节内骨折的特征与成人相似。

Pediatric calcaneal fractures: outcomes of surgical fixation and its characteristics

Objective The purpose of this study was to analyze the outcomes of surgical treatment of displaced intra-articular calcaneal fractures (ICFs) in children and its characteristics.Methods Between January 2004 and October 2008,we review the results of 9 displaced,intra-articular fractures in 8 skeletally immature patients,who were treated with open reduction and internal fixation in our hospital.There were 7 males and 1 female,with the mean age of 13.1 years (range:10 to 15 years).Preoperative radiographs and computed tomographic scans were used to classify fractures.Clinical and radiographic evaluation were performed in postoperative follow-up visits.The functional outcomes were assessed with use of the modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score.The published literatures of child ICFs treated with ORIF were reviewed.Results In the series,there were 4 tongue-type and 5 joint depression-type fractures according to Essex-Lopresti classification,and according to Sanders classification,we found 5 type-Ⅱ fractures,3 type-Ⅲ and 1 type-Ⅳ fractures.The mean follow-up time was 47.4 months (range:21 to 72 months).All fractures healed within 2 to 4 months.The average preoperative and postoperative Bohler angles were 5.7 and 33.1 degrees respectively,and the mean Gissane angles were 106.5 and 128.0 degrees respectively.The mean modified-AOFAS score was 65.2 points (range:53 to 68 points).Skin necrosis was found in one foot.After the review of literatures,78.6％ (48/61) of displaced ICFs were male in children.Based on the Sanders classification,36 of 67 (53.7％) were type-Ⅱ fractures,25 of 67 (37.3％) were type-Ⅲ and 6 of 67 (9.0％) were type-Ⅳ; And 15 of 37 (40.5％) were tongue-type,22 of 37 (59.5％) were joint depression-type fractures according to Essex-Lopresti classification.Conclusion Most children with displaced ICFs treated with ORIF had a good clinical outcome with few complications.The children and adolescents that were exposed to high-energy trauma suffer calcaneal fractures that were similar to adult fracture patterns.