摘要
目的:探讨关节镜辅助下手术治疗儿童跟骨关节内移位骨折的疗效。方法:回顾性分析2015年1月至2018年6月西南医科大学附属医院骨科收治的11例儿童跟骨骨折患者资料。男6例,女5例;年龄8~12岁,平均10.6岁;左足7例,右足4例;骨折按照Sanders分型:Ⅱ型10例,Ⅲ型1例。根据骨折程度在距下关节镜辅助下行撬拨复位及单纯克氏针内固定8例,克氏针+空心拉力螺钉固定3例。术后以石膏托或支具固定患足1个月,术后4~6周复查X线片见骨折愈合后取出克氏针。通过测量并比较患儿术前、术后B?hler角、Gissane角以评价跟骨解剖形态,采用美国足踝外科协会(AOFAS)的踝-后足评分评价患儿术后功能。结果:11例患儿均获随访,时间12~19个月,平均14个月。所有患儿均未植骨,手术时间50~75 min,平均63 min。切口均一期愈合,无切口感染发生。骨折均在2~3个月内愈合,无延迟愈合及不愈合。末次随访时B?hler角(28.4°±2.9°)、Gissane角(125.6°±3.1°)较术前(11.8°±5.4°、138.8°±6.3°)改善,差异均有统计学意义(P<0.05);末次随访时AOFAS的踝-后足评分为89.6分。结论:关节镜辅助下经皮撬拨复位,结合克氏针、空心拉力螺钉固定可以有效复位、固定儿童跟骨关节内移位骨折,手术创伤较小,疗效良好。
Objective To explore the clinical effects of arthroscopic treatment of intraarticular displaced fractures of the calcaneus in children.Methods The clinical data were analyzed retrospectively of the 11 children who had been treated for intraarticular displaced fractures of the calcaneus at Department of Orthopaedics,The Affiliated Hospital of Southwest Medical University from January 2015 to June 2018.They were 6 boys and 5 girls,aged from 8 to 12 years(average,10.6 years)and involving the left foot in 7 cases and the right foot in 4.By the Sanders classification,there were 10 cases of typeⅡand one of typeⅢ.Preoperative evaluation of the injury was conducted by X-ray examination and three-dimensional CT reconstruction of the calcaneus.After arthroscopic prying reduction,internal fixation with mere Kirschner wire was performed for 8 cases and internal fixation with Kirschner wire plus hollow screws for 3.The affected feet were fixated with plaster bracket or brace for one month after operation.The Kirschner wires were removed 4 to 6 weeks after operation when X-ray films revealed fracture union.The clinical effects were evaluated by anatomic recovery of the calcaneus in terms of preoperative and postoperative Böhler and Gissane angles and functional recovery of the calcaneus in terms of ankle-hindfoot scores of American Orthopedic Foot Ankle Society(AOFAS)scale.Results All the 11 pediatric patients were followed up for 12 to 19 months(average,14 months).No bone grafting was applied.Their operation time averaged 63 min(from 50 to 75 min).Their incisions healed at one stage without infection.All their fractures healed within 2 to 3 months without any delayed union or nonunion.The Böhler angle(28.4°±2.9°)and Gissane angle(125.6°±3.1°)at the final follow-up were significantly improved than the preoperative values(11.8°±5.4°and 138.8°±6.3°)(P<0.05).The AOFAS ankle-hindfoot scores were 89.6 points at the final follow-up.Conclusion Arthroscopic percutaneous prying reduction combined with internal fixation with Kirschner wire and hollow screws can effectively reduce and fixate the intraarticular displaced fracture of the calcaneus in children,leading to limited surgical trauma and fine curative effects.
作者
徐杨博
魏代清
邓勇
徐海林
Xu Yangbo;Wei Daiqing;Deng Yong;Xu Hailin(Department of Orthopaedics,The Affiliated Hospital of Southwest Medical University,Sichuan Provincial Laboratory of Orthopaedic Engineering,Luzhou 646000,Sichuan,China;Department of Trauma and Orthopedics,People's Hospital of Peking University,Beijing 100044,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第7期587-591,共5页
Chinese Journal of Orthopaedic Trauma
基金
四川省教育厅科研课题(18ZA0533)
四川省卫生健康委员会科研课题(16PJ549)。
关键词
关节镜
跟骨骨折
儿童
移位
Arthroscopy
Calcaneal fracture
Children
Displacement
