关节镜下双空心加压螺钉内固定治疗青少年股骨髁Salter-Harris Ⅲ型骨折
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摘要
目的探讨关节镜下双空心加压螺钉内固定治疗青少年股骨内髁Salter-Harris Ⅲ型骨折的临床疗效。方法笔者自2006-09—2014-08诊治23例青少年股骨内髁Salter-Harris Ⅲ型骨折,在关节镜下清理复位,在骺板远端用2枚4.5 mm的空心加压螺钉固定骨折。结果23例获得随访平均15.7(12~36)个月,手术时间为(28.92±5.04)min,所有的骨折解剖复位,术后3个月获骨性愈合,术后1年肢体长度较对侧无变化。Tegar评分术前(3.00±1.65)分,末次随访为(8.00±1.24)分;Lyshlom评分术前(25.43±10.04)分,末次随访为(92.00±3.91)分,末次随访Tegar评分、Lysholm评分较术前有较大改善,差异有统计学意义(t=-26.830,P<0.001;t=-11.218,P<0.001)。末次随访膝关节主动活动度:患侧活动度为(125.65±4.28)°,健侧活动度为(126.48±4.12)°,患侧与健侧比较差异无统计学意义(t=-0.890,P=0.445)。本组皆无感染、关节纤维化、下肢深静脉血栓形成。结论关节镜下双空心加压螺钉能最大程度解剖复位并坚强固定分离的股骨内髁和关节面,具有优良的短期临床效果。
Objective To investigate the clinical efficacy of arthroscopic treatment of Salter-Harris type Ⅲ fractures of the femoral condyle in adolescent. Methods From September 2006 to August 2014, 23 cases of adolescent femoral condylar fractures of Salter-Harris type Ⅲ were treated, with 2 hollow compression screws(4.5 mm) fixation of the distal epiphyseal plate under arthroscopy. Results Twenty-three patients were followed up for an average of 15.7(12-36)months. The operation time was(28.92±5.04)min. All of the fractures were anatomically reduced, and the bone healing was achieved in the first 3months after operation. The length of the limbs was unchanged one year after operation. The preoperative Tegar scores was 3.0(3.00±1.65)points,and 8.0(8.00 ±1.24)points at the final follow-up; Lyshlom score before operation was 25.4(25.43 ±10.04)points,and 92.0(92.00 ±3.91)points at the end of the follow-up. Tegar score and Lysholm score were greatly improved compared after operation, the difference was statistically significant(t =-26.830, P <0.001; t =-11.218, P <0.001). At the end of the follow-up, the active motion degree of the affected side was 125°(125.65±4.28) and the range of motion of the healthy side was 126°(126.48±4.12), and there was no significant difference between the affected side and the healthy side( t =-0.890,P =0.445). All the patients had no joint infection, fibrosis and lower extremity deep venous thrombosis. Conclusion Double hollow compression screws under arthroscopy can achieve the greatest degree of anatomical reduction and rigid fixation of the femoral condyle and articular surface, with excellent short-term clinical results.
Objective To investigate the clinical efficacy of arthroscopic treatment of Salter-Harris type Ⅲ fractures of the femoral condyle in adolescent. Methods From September 2006 to August 2014, 23 cases of adolescent femoral condylar fractures of Salter-Harris type Ⅲ were treated, with 2 hollow compression screws(4.5 mm) fixation of the distal epiphyseal plate under arthroscopy. Results Twenty-three patients were followed up for an average of 15.7(12-36)months. The operation time was(28.92±5.04)min. All of the fractures were anatomically reduced, and the bone healing was achieved in the first 3months after operation. The length of the limbs was unchanged one year after operation. The preoperative Tegar scores was 3.0(3.00±1.65)points,and 8.0(8.00 ±1.24)points at the final follow-up; Lyshlom score before operation was 25.4(25.43 ±10.04)points,and 92.0(92.00 ±3.91)points at the end of the follow-up. Tegar score and Lysholm score were greatly improved compared after operation, the difference was statistically significant(t =-26.830, P <0.001; t =-11.218, P <0.001). At the end of the follow-up, the active motion degree of the affected side was 125°(125.65±4.28) and the range of motion of the healthy side was 126°(126.48±4.12), and there was no significant difference between the affected side and the healthy side( t =-0.890,P =0.445). All the patients had no joint infection, fibrosis and lower extremity deep venous thrombosis. Conclusion Double hollow compression screws under arthroscopy can achieve the greatest degree of anatomical reduction and rigid fixation of the femoral condyle and articular surface, with excellent short-term clinical results.
引文
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[3]洪加源,练克俭,郭林新,等.跨骨骺滑动钢板固定治疗青少年股骨髁上A3型骨折[J].中国骨与关节损伤杂志,2011,26(4):292-294.
[4]于满秋,侯仁平.经皮穿针治疗儿童股骨髁上骨折[J].中国实用医药,2013,8(30):109-110.
[5]Salter RB,Harris WR.Injuries involving the epiphyseal plate[J].JBJS,1963,45(3):587-622.
[6]Pritchett JW.Longitudinal growth and growth-plate activity in the lower extremity[J].Clin Orthop,1992,275:274-279.
[7]Druschel C,Sawicki O,Cip J,et al.Biomechanical analysis of screw fixation vs.K-wire fixation of a slipped capital femoral epiphysis model[J].Biomed Tech(Berl),2012,57(3):157-162.
[8]宋兴建,刘淑萍,李建英.股骨远端骨骺损伤的治疗(附11例报告)[J].承德医学院学报,2001,18(4):300-301.
[9]苏义生,韦向东,蒙世远,等.105例儿童股骨髁上骨折治疗体会[J].中国矫形外科杂志,2011,18(12):1053-1054.
[10]郭立民,赵刚,王积光.小儿股骨近端骨骺损伤的治疗及并发症处理[J].实用骨科杂志,2006,12(4):358-359.
[11]马松立,赵晓山,曲家富,等.小儿股骨远端骨骺损伤[J].中华小儿外科杂志,1994,15(3):150-151.
[12]马松立,曲家富,韩海生,等.交叉细克氏针内固定治疗儿童股骨远端骨骺损伤[J].骨与关节损伤杂志,1996,11(5):312-313.