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目的:探讨个体化治疗儿童胫骨远端骨骺骨折的临床治疗效果。方法:回顾性分析我院2010年1月至2014年12月儿童胫骨远端骨骺骨折196例,其中男134例,女62例。年龄1.7~15.0岁,平均年龄(10.1±3.4)岁。根据Salter-Harris分型标准:Ⅰ型31例,Ⅱ型75例,Ⅲ型55例,Ⅳ型33例,Ⅴ型2例。根据年龄、受伤机制、营养状况、局部软组织血供情况、骨折类型等制订个体化治疗方案。结果:患者均获得随访,平均时间10~69(36.5±14.6)月,根据Mazur踝关节功能评价:所有病人总优良率为87.8%(172/196);各型骨折优良率为:Ⅰ型100%(31/31)、Ⅱ型88.0%(66/75)、Ⅲ型83.6%(46/55)、Ⅳ型84.8%(28/33)、Ⅴ型50.0%(1/2);各型骨折不同固定方法在优良率上均无统计学差异(P>0.05)。Ⅱ型骨折麻醉下闭合复位与切开复位在优良率上无统计学差异(P=1.000)。结论:儿童胫骨远端骨骺骨折应尽早明确诊断,将其分型并个体化选择治疗方法,对提高疗效,减少并发症的发生,恢复踝关节功能,具有重要的临床意义。
Objective: To explore the clinical effect of individualized treatment of distal tibial epiphyseal fractures in children. Methods: A retrospective analysis of our hospital from January 2010 to December 2014 196 cases of distal tibial epiphyseal fracture in children, including 134 males and 62 females. The age of 1.7 ~ 15.0 years, mean age (10.1 ± 3.4) years old. According to Salter-Harris classification criteria, there were 31 cases of type Ⅰ, 75 cases of type Ⅱ, 55 cases of type Ⅲ, 33 cases of type Ⅳ and 2 cases of type Ⅴ. According to age, injury mechanism, nutritional status, local soft tissue blood supply, type of fracture to develop individualized treatment programs. Results: The patients were followed up for an average of 10.69 months (36.5 ± 14.6 months). According to the Mazur ankle function evaluation, the overall excellent and good rates were 87.8% (172/196) in all patients. The excellent and good rates of each type of fractures were type Ⅰ 100 (31/31), type Ⅱ 88.0% (66/75), type Ⅲ 83.6% (46/55), type Ⅳ 84.8% (28/33), type Ⅴ 50.0% (1/2) There was no significant difference in the excellent and good rates between different fixation methods (P> 0.05). There was no significant difference in the excellent rate between type Ⅱ fractures under closed anesthesia and open reduction (P = 1.000). Conclusion: The diagnosis of distal tibial epiphyseal fractures in children should be diagnosed as soon as possible. It is of great clinical significance to improve the curative effect, reduce the incidence of complications and restore the function of the ankle joint by subdividing and selecting individual treatment methods.