有限内固定联合跨关节外固定架治疗儿童中足损伤

Ming-Chuan Lu, Xuemin Lu, Yi-jing Xu, Gui-sen Yan
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摘要

本研究旨在探讨儿童不稳定性中足损伤的临床特点及手术治疗方法。本研究纳入2009年6月至2016年10月在北京积水潭医院收治的11例严重不稳定中足损伤患儿,其中7例为Lisfranc损伤,4例为Chopart损伤。所有Lisfranc损伤均有来自健康侧的x线片资料,患侧x线片显示,所有损伤的Lisfranc关节与健康侧相比均分离大于3mm。治疗方法采用跨关节外固定架分散和维持内、外侧柱长度,结合保关节的经关节锁定钢板固定或经关节空心螺钉和克氏针穿过关节固定。随访17 ~ 110个月,共53.7个月。平均手术时间95.1分钟,平均术中出血量83.3 ml。11例患者中有9例使用外固定架分散固定内外侧柱。所有患者均实现骨愈合,没有患者抱怨中足部慢性疼痛。陈旧性骨折患儿术后平足、外翻畸形得到矫正,跟骰关节疼痛消失。最后一次随访时美国骨科足踝学会中足评分平均为93.4,其中9例大于90,2例在75 - 89之间。儿童足中部损伤以骨折脱位为特征。单纯的关节囊撕裂或韧带断裂是罕见的,经常伴有严重的长方体压缩性骨折。治疗应侧重于恢复骨结构的稳定性和内侧柱的长度。使用跨关节外固定架有助于维持复位并恢复内侧柱的长度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Limited internal fixation combined with a joint-spanning external fixator in the treatment of Midfoot injuries in children
The aim of this study was to explore the clinical features and surgical treatment methods of unstable midfoot injuries in children. Eleven children with severe unstable midfoot injuries admitted to Jishuitan Hospital, Beijing, from June 2009 to October 2016 were enrolled, including seven patients with Lisfranc injuries and four patients with Chopart injuries. All Lisfranc injuries had radiographic data from the healthy sides, and radiographs of the affected sides showed that all injured Lisfranc joints separated more than 3 mm compared with the healthy sides. The treatment methods employed a joint-spanning external fixator to distract and maintain the length of the medial and lateral columns, combined with joint-preserving trans-joint locking plate fixation or trans-articular cannulated screw and Kirschner wire fixation that passed through the joint. The patients were followed up for 53.7 months (17–110 months). The average operation time was 95.1 minutes, and the average intraoperative blood loss was 83.3 ml. Nine of the 11 patients were treated with an external fixator to distract and fix the medial or lateral column. Bone healing was achieved in all patients, and none of the patients complained of chronic pain in the midfoot. Flatfoot and valgus deformity were corrected after the surgery in the child with old fracture, and the pain in the calcaneocuboid joint disappeared. The average American Orthopedic Foot and Ankle Society mid-foot score at the last follow-up was 93.4, of which nine cases were greater than 90 and two cases were between 75 and 89. Children’s midfoot injury is characterized by fracture-dislocation. Simple joint capsule tear or ligament rupture is rare and often accompanied by severe cuboid compression fracture. The treatment should be focused on restoring the stability of the bony structure and the length of the medial and lateral columns. The use of a joint-spanning external fixator helps maintain reduction and restore the length of the medial and lateral columns.
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