CAJ | 학술논문

目的探讨儿童胫骨结节骨骺骨折的特点、治疗及预后.方法 1995年1月至2007年12月,胫骨结节骨骺骨折患儿28例,其中资料完整者25例,男23例,女2例;年龄12～16岁.平均13.5岁;左侧10例,右侧15例,均为单侧受累.损伤方式:打篮球时受伤10例,跳跃时受伤7例,踢足球时受伤8例.根据Ogden分型标准,1A型1例,1B型4例,2A型5例,2B型7例,3A型4例,3B型4例.除1例1A型患儿骨折采用闭合复位长腿石膏前后托固定外,余24例均采用切开复位拉力螺钉内固定.结果所有患儿均获得随访,随访时间14个月～7年,平均43个月.术后3个月患儿膝关节活动范围0°～140°,术后6个月恢复伤前运动水平.按照Mosier临床评价标准,结果均为优.所有病例手术切口均一期愈合,均未发生胫前间室综合征.骨折愈合时间2～5个月,平均3个月,伸膝装置序列正常,无一例患儿发生切口感染、内固定物失效或肢体畸形.结论儿童胫骨结节骨骺骨折是一种不常见的特殊类型的骺损伤.在伸膝装置突然加速或减速的运动中,当髌韧带的牵拉力超过胫骨结节骨骺、周围软骨膜以及邻近骨膜的结合力时,就会发生胫骨结节的骨骺骨折.该骨折多见于13～16岁的男性患儿,单侧发病为主;可采用拉力螺钉内固定治疗,术后患儿膝关节功能正常.
목적 탐토인동경골결절골후골절적특점、치료급예후.방법 1995년1월지2007년12월,경골결절골후골절환인28례,기중자료완정자25례,남23례,녀2례;년령12～16세.평균13.5세;좌측10례,우측15례,균위단측수루.손상방식:타람구시수상10례,도약시수상7례,척족구시수상8례.근거Ogden분형표준,1A형1례,1B형4례,2A형5례,2B형7례,3A형4례,3B형4례.제1례1A형환인골절채용폐합복위장퇴석고전후탁고정외,여24례균채용절개복위랍력라정내고정.결과 소유환인균획득수방,수방시간14개월～7년,평균43개월.술후3개월환인슬관절활동범위0°～140°,술후6개월회복상전운동수평.안조Mosier림상평개표준,결과균위우.소유병례수술절구균일기유합,균미발생경전간실종합정.골절유합시간2～5개월,평균3개월,신슬장치서렬정상,무일례환인발생절구감염、내고정물실효혹지체기형.결론 인동경골결절골후골절시일충불상견적특수류형적후손상.재신슬장치돌연가속혹감속적운동중,당빈인대적견랍력초과경골결절골후、주위연골막이급린근골막적결합력시,취회발생경골결절적골후골절.해골절다견우13～16세적남성환인,단측발병위주;가채용랍력라정내고정치료,술후환인슬관절공능정상.
Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.