Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of p...Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of post-traumatic pediatric ankle varus deformity using physeal bar resection and hemi-epiphysiodesis with the assistance of two operative methods.Forty-five patients presenting with a distal tibial medial physeal bridge as well as ankle varus deformity following traumatic ankle physeal injury between 2009 and 2017 were followed.These patients were treated w让h physeal bar resection and hemi-epiphysiodesis,with the assistance of either fluoroscopy (10 cases) or intraoperative three-dimensional navigation (35 cases).Of the 45 cases,the median age was 9.0 years (range:3-14 years) with 28 male and 17 female patients.The median of pre-operation ankle varus angle was 20 degrees (IQR 15-25) and 5 degrees (IQR 0-20) at the time of final follow up,representing a statistically significant difference (P<0.05).No differences were observed with regards to age,gender,and surgical history between effective group and ineffective group (P>0.05).The median of pre-operative ankle varus angles of the navigation and fluoroscopy groups were both 20 degrees (P>0.05).The median correction angle of the navigation and fluoroscopy groups was 10 and 15 degrees,respectively (P>0.05).Our results indicate that physeal bar resection and hemiepiphysiodesis are effective treatments for correcting ankle varus deformity due to traumatic medial physeal arrest of the distal tibia.We observe no difference in outcome between fluoroscopy group and three-dimensional navigation group during the procedures.展开更多
BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop ...BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.展开更多
The physis of a long bone may get ＇sandwiched＇ and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular def...The physis of a long bone may get ＇sandwiched＇ and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft. On table image intensifier controlled distraction of the crushed physis was done to bring the height of the physis similar to that of the opposite limb. Patients were followed up for more than two years clinically and radio- logically. There was no clinical or radiological angular deformity of the operated limbs. MRI scans showed intact physes with no physeal bar formation in either of the two patients. The distraction obtained by the ring fixator appears to have provided ample ＇breathing space＇ to the compressed physis and that the growth potential may have been re-gained by the procedure. However, two years is a relatively short duration of follow-up and further follow-up of longer duration and in greater number of patients is needed to gauge the actual effectiveness of the technque used bv us.展开更多
Either proximal tibial or tibial physeal injuries are rare. The combination of both is even rarer, let alone causes a vascular injury. Early intervention is the key for management. We hereby present an interesting cas...Either proximal tibial or tibial physeal injuries are rare. The combination of both is even rarer, let alone causes a vascular injury. Early intervention is the key for management. We hereby present an interesting case of simultaneous proximal tibiofibular physeal injury with popliteal arterial occlusion and common peroneal nerve injury. The present case is important in two aspects： firstly it reports a very rare occurrence of simultaneous proximal tibiofibular physeal injury associated with vascular insult and common peroneal nerve injury; secondly it highlights that with timely intervention excellent results can be achieved in paediatric patients.展开更多
目的分析骨骺牵开保骺术在儿童股骨骨肉瘤保肢术中的疗效及应用价值。方法 2007年1月-2011年1月,收治6例股骨远端骨肉瘤患儿。男4例,女2例;年龄9～14岁,平均11.4岁。病程1～9个月,平均4.8个月。术前经穿刺或切开活检证实为骨肉瘤,其中...目的分析骨骺牵开保骺术在儿童股骨骨肉瘤保肢术中的疗效及应用价值。方法 2007年1月-2011年1月,收治6例股骨远端骨肉瘤患儿。男4例,女2例;年龄9～14岁,平均11.4岁。病程1～9个月,平均4.8个月。术前经穿刺或切开活检证实为骨肉瘤,其中成骨型骨肉瘤1例,软骨母细胞型骨肉瘤1例,骨母细胞型骨肉瘤1例,未明确细胞分类的骨肉瘤3例。根据Enneking提出的外科分期系统,其中ⅡA期1例,ⅡB期5例。术前采用新辅助化疗2个周期;首先行Ca adell骨骺牵开保骺术,牵开时间4～7 d,平均5.7 d;骨骺牵开保骺术完成1～2 d后行骨肿瘤切除,采用大段同种异体骨移植重建;术后进一步化疗并定期随访了解骨折愈合、下肢发育及局部和全身并发症等情况,并根据美国肌肉骨骼肿瘤学会(MSTS)评分系统评分及双膝关节活动度(range of motion,ROM)进行功能评定。结果术后发生切口浅表感染1例,经换药治疗后愈合;其余患儿切口均Ⅰ期愈合。6例均获随访,随访时间1～5年,平均2.5年;无明显肢体肿胀及疼痛等症状,未发生同种异体骨排斥反应及内固定物松动、断裂等。术后随访无肿瘤转移及局部复发等并发症发生。术后6～9个月干骺端骨性愈合5例,14个月1例;骨干部位均发生延迟愈合,术后12～48个月骨折端均有不同程度骨痂形成,但骨折线仍清晰可见。末次随访时患肢短缩1～3 cm 4例,3～5 cm 2例;发生代偿性脊柱侧弯3例,行走明显跛行2例;MSTS评分为(27.20±1.92)分,与术前(19.60±2.74)分比较差异有统计学意义(t=—4.12,P=0.00);患侧膝关节ROM为(127.00±17.89)°,与术前(109.00±12.45)°比较差异无统计学意义(t=—1.84,P=0.10),与健侧膝关节ROM(126.00±9.62)°比较差异无统计学意义(t=—0.11,P=0.92)。结论骨骺牵开保骺术可应用于骨骺尚未闭合的儿童股骨骨肉瘤保肢术中,具有操作简便、临床疗效好、术后并发症少等优点。展开更多
目的分析导航下骺开放(physeal bar resection,PBR)治疗儿童创伤性胫骨远端骺早闭所致踝内翻畸形的临床特点,探讨影响骺开放成功的相关因素。方法回顾性分析首都医科大学附属北京积水潭医院小儿骨科2002年6月至2021年10月收治的儿童创...目的分析导航下骺开放(physeal bar resection,PBR)治疗儿童创伤性胫骨远端骺早闭所致踝内翻畸形的临床特点,探讨影响骺开放成功的相关因素。方法回顾性分析首都医科大学附属北京积水潭医院小儿骨科2002年6月至2021年10月收治的儿童创伤性胫骨远端骺早闭所致踝内翻,并接受导航下骺开放患儿的临床资料。统计其性别、年龄、受伤机制、骨桥形态、受伤至手术时间、骺阻滞方式、截骨方式、畸形矫正时间,并测量胫骨远端外侧角(lateral distal tibial angle,LDTA)。根据患儿影像学资料,将其分为骺开放成功组及骺开放失败组;以男12岁、女10岁为界,将患儿分为高生长潜力组、低生长潜力组;结合其他临床资料,通过多因素Logistic回归分析影响骺开放成功的因素。结果本研究共纳入63例患儿,手术时年龄(9.1±2.5)岁,随访32.0(22.0,54.0)个月,受伤至接受骺开放时间为18.0(13.0,28.0)个月。高生长潜力组共47例,其中男30例、女17例;低生长潜力组共16例,其中男9例、女7例。所有患儿接受导航下骺开放手术,同期行胫骨远端外侧骺阻滞25例,同期行截骨11例。骺开放成功组术前LDTA为(108.1±5.5)°,骺开放失败组术前LDTA为(112.7±6.2)°,差异有统计学意义(t=-3.129,P=0.003)。多因素Logistic回归分析结果显示:生长潜力(OR=15.122,95%CI:2.076~110.159,P=0.007)和术前LDTA(OR=0.855,95%CI:0.755~0.969,P=0.014)是骺开放是否成功的独立影响因素。结论儿童创伤性胫骨远端骺早闭所致踝内翻畸形的骺开放治疗具有挑战性,生长潜力、术前LDTA是影响手术结果的重要因素。准确评估骺板功能及生长潜力、合理手术决策、导航术中精确操作以及术后严密随访是手术成功的关键。展开更多
文摘Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of post-traumatic pediatric ankle varus deformity using physeal bar resection and hemi-epiphysiodesis with the assistance of two operative methods.Forty-five patients presenting with a distal tibial medial physeal bridge as well as ankle varus deformity following traumatic ankle physeal injury between 2009 and 2017 were followed.These patients were treated w让h physeal bar resection and hemi-epiphysiodesis,with the assistance of either fluoroscopy (10 cases) or intraoperative three-dimensional navigation (35 cases).Of the 45 cases,the median age was 9.0 years (range:3-14 years) with 28 male and 17 female patients.The median of pre-operation ankle varus angle was 20 degrees (IQR 15-25) and 5 degrees (IQR 0-20) at the time of final follow up,representing a statistically significant difference (P<0.05).No differences were observed with regards to age,gender,and surgical history between effective group and ineffective group (P>0.05).The median of pre-operative ankle varus angles of the navigation and fluoroscopy groups were both 20 degrees (P>0.05).The median correction angle of the navigation and fluoroscopy groups was 10 and 15 degrees,respectively (P>0.05).Our results indicate that physeal bar resection and hemiepiphysiodesis are effective treatments for correcting ankle varus deformity due to traumatic medial physeal arrest of the distal tibia.We observe no difference in outcome between fluoroscopy group and three-dimensional navigation group during the procedures.
文摘BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.
文摘The physis of a long bone may get ＇sandwiched＇ and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft. On table image intensifier controlled distraction of the crushed physis was done to bring the height of the physis similar to that of the opposite limb. Patients were followed up for more than two years clinically and radio- logically. There was no clinical or radiological angular deformity of the operated limbs. MRI scans showed intact physes with no physeal bar formation in either of the two patients. The distraction obtained by the ring fixator appears to have provided ample ＇breathing space＇ to the compressed physis and that the growth potential may have been re-gained by the procedure. However, two years is a relatively short duration of follow-up and further follow-up of longer duration and in greater number of patients is needed to gauge the actual effectiveness of the technque used bv us.
文摘Either proximal tibial or tibial physeal injuries are rare. The combination of both is even rarer, let alone causes a vascular injury. Early intervention is the key for management. We hereby present an interesting case of simultaneous proximal tibiofibular physeal injury with popliteal arterial occlusion and common peroneal nerve injury. The present case is important in two aspects： firstly it reports a very rare occurrence of simultaneous proximal tibiofibular physeal injury associated with vascular insult and common peroneal nerve injury; secondly it highlights that with timely intervention excellent results can be achieved in paediatric patients.
文摘目的分析骨骺牵开保骺术在儿童股骨骨肉瘤保肢术中的疗效及应用价值。方法 2007年1月-2011年1月,收治6例股骨远端骨肉瘤患儿。男4例,女2例;年龄9～14岁,平均11.4岁。病程1～9个月,平均4.8个月。术前经穿刺或切开活检证实为骨肉瘤,其中成骨型骨肉瘤1例,软骨母细胞型骨肉瘤1例,骨母细胞型骨肉瘤1例,未明确细胞分类的骨肉瘤3例。根据Enneking提出的外科分期系统,其中ⅡA期1例,ⅡB期5例。术前采用新辅助化疗2个周期;首先行Ca adell骨骺牵开保骺术,牵开时间4～7 d,平均5.7 d;骨骺牵开保骺术完成1～2 d后行骨肿瘤切除,采用大段同种异体骨移植重建;术后进一步化疗并定期随访了解骨折愈合、下肢发育及局部和全身并发症等情况,并根据美国肌肉骨骼肿瘤学会(MSTS)评分系统评分及双膝关节活动度(range of motion,ROM)进行功能评定。结果术后发生切口浅表感染1例,经换药治疗后愈合;其余患儿切口均Ⅰ期愈合。6例均获随访,随访时间1～5年,平均2.5年;无明显肢体肿胀及疼痛等症状,未发生同种异体骨排斥反应及内固定物松动、断裂等。术后随访无肿瘤转移及局部复发等并发症发生。术后6～9个月干骺端骨性愈合5例,14个月1例;骨干部位均发生延迟愈合,术后12～48个月骨折端均有不同程度骨痂形成,但骨折线仍清晰可见。末次随访时患肢短缩1～3 cm 4例,3～5 cm 2例;发生代偿性脊柱侧弯3例,行走明显跛行2例;MSTS评分为(27.20±1.92)分,与术前(19.60±2.74)分比较差异有统计学意义(t=—4.12,P=0.00);患侧膝关节ROM为(127.00±17.89)°,与术前(109.00±12.45)°比较差异无统计学意义(t=—1.84,P=0.10),与健侧膝关节ROM(126.00±9.62)°比较差异无统计学意义(t=—0.11,P=0.92)。结论骨骺牵开保骺术可应用于骨骺尚未闭合的儿童股骨骨肉瘤保肢术中,具有操作简便、临床疗效好、术后并发症少等优点。
