| 青少年胫骨远端Salter-Harris Ⅱ型骨骺骨折闭合与切开复位螺钉内固定的疗效分析 |
| Efficacy analysis of closed and open reduction and screw internal fixation for tibial distal Salter-Harris typeⅡ epiphyseal fractures in adolescents |
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| DOI： |
| 中文关键词: 青少年 胫骨远端Salter-Harris Ⅱ型骨骺骨折 闭合复位 切开复位 螺钉固定 |
| 英文关键词:Teenagers Distal tibia Salter-Harris Ⅱ epiphyseal fracture Closed reduction Open reduction Screw fixation |
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| 通讯作者:辜刘伟1 刘冬雪2 周霖3 刘德森3 王玉琦3 阮思源3 曹洪1* |
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| 中文摘要: |
| 目的 观察对比青少年胫骨远端Salter-Harris Ⅱ型骨骺骨折闭合与切开复位螺钉内固定术后并发症的发生率及疗效。方法 对十堰市人民医院2015年10月至2019年10月收治的52例胫骨远端Salter-Harris Ⅱ型骨骺骨折的青少年患者进行回顾性研究，根据手术方式分为切开复位螺钉内固定（切开复位组，20例）与闭合复位经皮螺钉内固定（闭合复位组，32例）两组，并对术中手术时间、出血量、住院时间、术后随访24个月的AOFAS踝-后足评分优良率及影像学检查显示对骺板发育的影响进行对比研究。结果 52例患者均进行24个月的随访。两组患者在手术时间上比较无明显差异（P＞0.05）；与切开复位组相比，闭合复位组术中出血量更少，术中对患肢皮肤血供的影响更小，术后皮肤条件较切开复位内固定组更好，但术后皮肤坏死率比较差异无统计学意义。两组在术后对足踝关节功能的影响，如行走疼痛、行走不稳等，闭合复位组均较切开复位组对足踝功能影响小，但在对骺板早闭的影响并无统计学意义。在术后足踝内外翻畸形的发生率方面差异无统计学意义，但闭合复位内固定组的平均住院时间更短（P＜0.05）。两组术后AOFAS踝-后足评分优良率方面，闭合复位组术后优良率（93.75%）较切开复位内固定组（70.00%）更高，差异有统计学意义（P＜0.05）。结论 在青少年的胫骨远端Salter-Harris Ⅱ型骨骺骨折中，使用闭合复位经皮螺钉内固定疗效较好，可作为一种可选择的临床治疗方案。 |
| 英文摘要: |
| Objective To compare the incidences and effectiveness of complications after closed and open reduction and screw internal fixation of Salter-Harris type Ⅱ epiphyseal fracture of distal tibia in adolescents. Methods A retrospective study was conducted on 52 adolescent patients with Salter-Harris type Ⅱ epiphyseal fracture of distal tibia treated in Shiyan People's Hospital from October 2015 to October 2019. According to the operation method, they were divided into open reduction screw internal fixation(20 cases) and closed reduction percutaneous screw internal fixation(32 cases) groups. The intraoperative operation time, amount of bleeding, length of stay in the hospital and AOFAS were analyzed. The excellent and good rate of AOFAS ankle hindfoot score and the effect of imaging examination on the development of epiphyseal plate were compared. Results The 52 patients were followed up for 24 months. There was no significant difference in operation time between the two groups. Compared with the open reduction and internal fixation group, the closed reduction and internal fixation group had less intraoperative bleeding, less impact on the skin blood supply of the affected limb, and better postoperative skin conditions than the open reduction and internal fixation group. However, there was no significant difference in the rate of skin necrosis after operation. There was no significant difference in the incidence of ankle valgus deformity after operation, but the average hospital stay in the closed reduction and internal fixation group was shorter(P<0.05). In terms of the incidence of ankle varus deformity after operation, the closed reduction group also had an advantage, and the average hospital stay in the closed reduction and internal fixation group was shorter. In terms of the excellent and good rate of AOFAS ankle hindfoot score in the two groups, the excellent and good rate after operation in the closed reduction group (93.75%) was higher than that in the open reduction and internal fixation group (70.00%) (P<0.05). Conclusion In adolescents with Salter-Harris type Ⅱ epiphyseal fracture of distal tibia, closed reduction and percutaneous screw internal fixation is effective, which can be used as an alternative clinical treatment. |
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