空心螺钉与克氏针固定治疗儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折的疗效比较
Comparison of cannulated screws and Kirschner wires in the treatment of pediatric medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ
潘源城 1卢凤珊 2陈添来 1马洪 2郭跃明 2李伟强 2陈顺有1
作者信息
- 1. 福州市第二总医院小儿骨科,福建省创伤骨科急救与康复临床医学研究中心,福州 350007
- 2. 佛山市中医院小儿骨科,佛山 528000
- 折叠
摘要
目的 比较空心螺钉与克氏针固定治疗儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折的疗效.方法 回顾性分析福州市第二总医院小儿骨科和佛山市中医院小儿骨科自2016年6月至2022年6月分别收治的48、16例儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折患者资料.男32例,女32例;年龄12(10,14)岁;左侧31例,右侧33例;骨折Salter-Harris分型:Ⅲ型45例,Ⅳ型19例.根据内固定方式不同分为2组:空心螺钉组44例(采用空心螺钉固定),克氏针组20例(采用克氏针固定).末次随访时摄踝关节正、侧位X线片对两组患儿进行影像学评估,并根据踝关节活动度和美国足踝外科协会(AOFAS)踝-后足评分评定患肢功能恢复情况,同时记录相关并发症.结果 除侧别外,两组患儿术前一般资料比较差异均无统计学意义(P>0.05),具有可比性.所有患儿术后获(37.3±21.5)个月随访,骨折均获骨性愈合.末次随访时空心螺钉组与克氏针组患儿患侧胫骨远端外侧角分别为89.0°(89.0°,90.0°)、89.0°(89.0°,90.0°),踝关节活动度分别为 73.5°(67.8°,76.0°)、70.0°(70.0°,75.0°),AOFAS踝-后足评分优良率分别为97.7％(43/44)、95.0％(19/20),以上项目两组间比较差异均无统计学意义(P>0.05).空心螺钉组与克氏针组患儿术后骨骺早闭发生率分别为36.4％(16/44)和65.0％(13/20),差异有统计学意义(P=0.033).结论 空心螺钉与克氏针固定治疗儿童内踝Salter-Harris Ⅲ、Ⅳ型骨折均可获得良好的功能结果.然而,空心螺钉固定在减少骨骺早闭的风险方面更有优势.
Abstract
Objective To compare the therapeutic effects of cannulated screws and Kirschner wires in the treatment of medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ in children.Methods A retrospective study was conducted to analyze the data of 48 and 16 children who had been treated respectively at Department of Pediatric Orthopaedics,Fuzhou Second General Hospital,and Department of Pediatric Or-thopaedics,Foshan Hospital of Traditional Chinese Medicine for medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ from June 2016 to June 2022.There were 32 males and 32 females with an age of 12(10,14)years;31 left and 33 right sides were affected.By the Salter-Harris classification:type Ⅲ in 45 cases,and type Ⅳ in 19 cases.The patients were divided into 2 groups according to their internal fixation methods.Group A(44 cases)was subjected to internal fixation with cannulated screws and group B(20 cases)to internal fixa-tion with Kirschner wires.At the last follow-up,anteroposterior and lateral X-ray films of their ankle joints were taken for imaging evaluation.Functional recovery of the affected limbs was evaluated based on the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scoring,and related complications were recorded.Results The 2 groups were comparable because there were no significant differences in their preoperative general data except laterality(P＞0.05).All the patients were followed up for(37.3±21.5)months and achieved bony union.At the last follow-up,for groups A and B respectively,the distal lateral angle of the tibia was 89.0°(89.0°,90.0°)and 89.0°(89.0°,90.0°),the range of ankle motion was 73.5°(67.8°,76.0°)and 70.0°(70.0°,75.0°),and the good and excellent rate by the AOFAS ankle-hindfoot scoring was 97.7％(43/44)and 95.0％(19/20),showing no significant difference between the 2 groups(P＞0.05).There was a significant difference between the 2 groups in the incidence of premature physeal closure[36.4％(16/44)versus 65.0％(13/20)](P=0.033).Conclusions In the treatment of medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ in children,internal fixation with both cannulated screws and Kirschner wires can lead to comparable efficacy in good functional recovery and imaging evalua-tion.However,fixation with cannulated screws may be more advantageous in reducing the risk of early clo-sure of the epiphysis.
关键词
儿童/骨折固定术,内/踝关节/Salter-Harris分型Key words
Children/Fracture fixation,internal/Ankle Joint/Salter-Harris classification引用本文复制引用
基金项目
福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014)
福州市临床重点专科建设项目(20220104)
出版年
2024
NETL
NSTL
万方数据