儿童闭合性胫腓骨骨折的外固定架治疗

目的探讨儿童闭合性胫腓骨骨折Orthofix单臂外固定架治疗的疗效,分析外固定架治疗的优缺点。方法 2001年8月～2008年11月,应用单臂外固定架(Orthofix SRL公司)治疗169例儿童胫腓骨骨折,其中单侧闭合骨折97例纳入本组。采用在C形臂或G形臂透视下进行闭合复位,Orthofix外固定架固定。结果手术时间35～160min,平均54min;出血量都在10ml以下。17例固定过程中出现Ⅰ～Ⅱ级针道感染,通过换药等手段控制,无一例因针道感染导致外固定架失效。固定过程中膝关节及踝关节活动均不受影响。骨性愈合时间12～24周,平均14.2周。23例过度生长不超过1cm。97例术后随访15～39个月,平均31个月,骨折全部骨性愈合。结论应用外固定架治疗儿童闭合性胫腓骨骨折,不破坏骨折端血运,且可提供牢固固定,允许早期关节活动及负重练习,减轻了护理负担。

External Fixator for Closed Tibiofibular Fractures in Children

Objective To discuss the results and advantages of the treatment of closed tibiofibular fractures in children with Orthofix single-frame external fixator. Methods From August 2001 to November 2008, 169 children with tibiofibular fractures were treated with Orthofix single-frame external fixator （Orthofix, England） in our hospital. In the patients, 97 had unilateral closed fractures and thus were included in this study. Close reductions were performed on the patients under the guidance of C-or G-arm fluorescence image intensifier, and then immobilized by Orthofix single-frame external fixators. Results The operation time in our patients ranged from 35 to 160 minutes with a mean of 54 minutes. During the operation, no patient had blood loss more than 10 ml. Paley Ⅰ-Ⅱ degree pin infection was detected during the process of fixation in 17 cases, and then was controlled without leading to failure in external fixation. The range-of-motion of the knee and ankle joints during fixating was in a good condition. Follow-up examination showed that osseous healing was achieved in 12 to 24 weeks （mean, 14.2 weeks）; and overgrowth of the affected lower limb was found in 23 patients, with the length less than 1 cm.The 97 patients were followed up for 15 to 39 months with a mean of 31 months, during which bone fracture healing was detected in all of the cases. Conclusion Orthofix single-frame external fixator is effective for closed tibiofibular fractures in children without breaking the blood supplying to the fracture site while providing firm immobilization, and thus allowing early ROM exercising and weight-bearing.