手法复位空心螺钉固定治疗儿童胫骨远端三平面骨折

目的 评估采用手法复位、经皮空心螺钉固定方法治疗儿童胫骨远端三平面骨折的疗效.方法 2004年9月至2009年3月,采用手法复位、空心螺钉固定方法治疗胫骨远端三平面骨折15例.男9例,女6例.术前经X线片或CT检查确诊.全部病例均为闭合性骨折,经手法复位治疗失败(X线片上骺板及关节面骨折间隙＞2mm)后行手术治疗.手术在"C"型臂X线机监视下进行,行踝关节轴向牵引,根据骨折类型内旋或外旋足,达到解剖复位后行经皮空心螺钉固定.术后行CT检查,确定骨折解剖复位,骺板及关节面骨折间隙＜2mm.术后石膏托固定8周.以改良Weber评估标准评价踝关节功能及愈合情况.结果 全部病例随访15-68个月,平均26个月.末次随访时按改良Weber评分,优13例,良2例.X线片检查所有病例均骨性愈合,未发现骨桥形成及关节面不平整现象,无肢体旋转和短缩畸形.所有患儿均能参加正常的体育活动.2例结果为良的患儿均与负重过早有关,主要表现为充分用力时患侧踝关节有轻度疼痛感.结论 对于闭合性胫骨远端三平面骨折手法复位失败者,采用手法复位、经皮空心螺钉固定方法手术操作简单,疗效满意.

Manipulative reduction and percutaneous cannulated screws fixation for triplane fractures of the distal tibia in children

Objective To evaluate the result of manipulative reduction and percutaneous cannulated screws fixation for the triplane fracture of the distal tibia in children. Methods From September 2004 to March 2009, 15 cases of triplane fracture of the distal tibia were treated with manipulative reduction and percutaneous cannulated screws fixation. This study included 9 boys with an average age of 13.2 years (range, 12-14 years) and 6 girls with an average age of 12.4 years (range, 11-14 years). Preoperative diagnoses were confirmed by the X-ray films or CT examination. If plain radiographs showed the fracture gap of epiphysis board and articular surface were greater than 2 mm after closed reduction, the operation was needed. Under "C"-arm X-ray machine, anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous cannulated screw. Postoperative CT scanning confirmed anatomical reduction. All patients had been immobilized with cast for 8 weeks. The ankle joint function and growth were evaluated by modified Weber protocol. Results All patients were followed up for 15 to 68 months with an average of 26 months. There were excellent in 13 cases, good in 2 cases. X-ray films showed all fractures were healed. There were not bone bridge and uneven articular surface, or rotating and shortening deformity. All patients could participate in the normal physical activities. The 2 cases with good outcome were related to weight-bearing too early. The main problem was that pain occurred in ankle joint with excess activity. Conclusion The method of manipulative reduction and percutaneous cannulated screw fixation is relatively reliable treatment for closed triplane fractures of the distal tibia.