摘要
目的回顾性评估儿童跟骨关节内骨折的手术治疗效果，并总结儿童跟骨关节内骨折的特征。方法2004年1月至2008年10月，对8例9足儿童闭合性跟骨关节内骨折行手术治疗，男7例，女1例；年龄1叶15岁，平均13．1岁。术前通过X线片及CT检查对骨折情况进行评估和分型，术后通过临床检查及X线片随访，临床评估使用改良AOFAS评分。并对已发表的手术治疗儿童跟骨关节内骨折的文献进行综合分析。结果按照Essex—Lopresti分型，舌型骨折4例4足，关节压缩型5例5足；按照Sanders分型，Ⅱ型5例5足，Ⅲ型3例3足，Ⅳ型1例1足。均获得21-72个月随访，平均47．4个月。平均骨折愈合时间为2．8个月（2-4个月）。术前及术后Bohler角分别平均为5．7°和33．1°，Gissane角分别平均为106．5°和128．0°；平均改良AOFAS评分为65．2分（53-68分）。有1足出现皮缘局部坏死，无其他并发症发生。文献综合结果，儿童跟骨关节内骨折患者，男性占78．6％（48／61）；SandersⅡ型占53．7％（36／67），Ⅲ型占37．3％（25／67），Ⅳ型占9．0％（6／67）；Essex—Lopresti舌型骨折占40．5％（15／37），关节压缩型占59．5％（22／37）。结论儿童闭合性跟骨关节内骨折，通过手术治疗恢复较快且预后良好，并发症发生率低。儿童跟骨关节内骨折的特征与成人相似。
Objective The purpose of this study was to analyze the outcomes of surgical treatment of displaced intra-articular calcaneal fractures （ICFs） in children and its characteristics. Methods Between January 2004 and October 2008, we review the results of 9 displaced, intra-articular fractures in 8 skeletally immature patients, who were treated with open reduction and internal fixation in our hospital. There were 7 males and 1 female, with the mean age of 13.1 years （range： 10 to 15 years）. Preoperative radiographs and computed tomographic scans were used to classify fractures.Clinical and radiographic evaluation were performed in postoperative follow-up visits. The functional outcomes were assessed with use of the modified American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hindfoot score. The published literatures of child ICFs treated with ORIF were reviewed. Results In the series, there were 4 tongue-type and 5 joint depression-type fractures according to Essex-Lopresti classification,and according to Sanders classification, we found 5 type-Ⅱ fractures, 3 type-Ⅲ and 1 type-Ⅳ fractures. The mean follow-up time was 47.4 months （range： 21 to 72 months）.Ail fractures healed within 2 to 4 months. The average preoperative and postoperative Bohler angles were 5.7 and 33.1 degrees respectively, and the mean Gissane angles were 106.5 and 128.0 degrees respectively. The mean modified-AOFAS score was 65.2 points （range： 53 to 68 points）. Skin necrosis was found in one foot. After the review of literatures, 78.6% （48/61） of displaced ICFs were male in children. Based on the Sanders classification, 36 of 67 （53.7%） were type-Ⅱ fractures, 25 of 67 （37.3%） were type-Ⅲ and 6 of 67 （9.0%） were type-Ⅳ; And 15 of 37 （40.5%） were tongue-type, 22 of 37 （59.5%） were joint depression-type fractures according to Essex-Lopresti classification. Conclusion Most children with displaced ICFs treated with ORIF had a good clinical outcome with few complications. The children and adolescents that were exposed to high-energy trauma suffer calcaneal fractures that were similar to adult fracture patterns.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2011年第12期1319-1324,共6页
Chinese Journal of Orthopaedics
关键词
跟骨
骨折
闭合性
儿童
治疗结果
Calcaneus
Fractures, closed
Child
Treatment outcome
