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目的探讨儿童浮膝损伤的治疗方法及疗效。方法回顾性分析2008年1月至2014年6月入院的19例浮膝损伤的患儿,其中男12例,女7例;年龄1岁4个月至15岁,平均7岁10个月。左侧8例,右侧10例,双侧1例。致伤原因:交通事故16例;机器绞伤1例;乘坐自行车摔伤1例,跌倒1例。改良Bohn and Durbin分型:Ⅰ型10例(11侧),Ⅱ型6例,Ⅲa型3例。单独胫骨开放骨折4例,股骨、胫骨同时开放骨折2例。合并失血性休克3例,合并颅脑损伤3例,腹部闭合性损伤1例,其它部位骨折10例,合并腓总神经损伤1例,血管损伤1例,骨筋膜室综合征1例,合并皮肤剥脱伤2例。2例年龄<3岁患儿保守治疗,其它均采用手术治疗。结果随访12~48个月,平均18个月。伤口乙级愈合1例,其余均甲级愈合。骨折均达骨性愈合。腓总神经损伤于8周内完全恢复。下肢膝外翻畸形2例,均发生在胫骨近端骨折患儿。双下肢明显不等长(>2 cm)1例。根据Yue等评价标准进行评价:优15例,良1例,可2例,差1例。结论 3岁以下患儿牵引治疗效果良好。手术是治疗3岁以上患儿浮膝损伤的有效方法,根据损伤的“个性”对浮膝损伤制订不同的治疗方案,可有效地减少并发症。
Objective To investigate the treatment and efficacy of children’s knee injury. Methods A retrospective analysis of 19 children with knee injury who were admitted to hospital from January 2008 to June 2014 was performed, including 12 males and 7 females. The patients aged 1 year and 4 months to 15 years old averaged 7 years and 10 months. Left in 8 cases, right in 10 cases, bilateral in 1 case. Causes of injury: 16 cases of traffic accidents; 1 case of machine snapping; 1 case of bicycle injury, 1 case of falls. Improved Bohn and Durbin classification: Ⅰ type 10 cases (11 sides), Ⅱ type 6 cases, Ⅲ a type 3 cases. Open tibia alone in 4 cases, femur, tibia at the same time open fractures in 2 cases. 3 cases of combined hemorrhagic shock, brain injury in 3 cases, closed abdominal injury in 1 case, other parts of the fracture in 10 cases, 1 case of common peroneal nerve injury, vascular injury in 1 case, osteofascial compartment syndrome in 1 case, combined Skin exfoliation in 2 cases. Two cases of children aged <3 years of conservative treatment, the other were treated by surgery. The results were followed up for 12 to 48 months, an average of 18 months. B wound healing in 1 case, the rest are grade A healed. Fractures are up to bone healing. Common peroneal nerve injury recovered completely within 8 weeks. Lower extremity knee valgus deformity in 2 cases, both occurred in the proximal tibial fractures in children. Double lower extremity was significantly unequal length (> 2 cm) in 1 case. According to Yue and other evaluation criteria for evaluation: excellent in 15 cases, good in 1 case, fair in 2 cases, poor in 1 case. Conclusion Children under 3 years of traction have a good effect. Surgery is an effective method to treat floating knee injury in children over 3 years old. Different treatment plans for knee injury are based on the “personality” of the injury, which can effectively reduce the complications.