CAJ | 학술논문

目的对青少年胫骨结节撕脱性骨折临床治疗结果进行分析,并回顾以往文献报告,总结该病的治疗及预后.方法回顾性分析2003年1月至2008年6月间9例采用非手术和手术方法治疗的胫骨结节撕脱性骨折患儿,均为男性,年龄12岁10个月～16岁3个月,平均年龄14岁7个月;体重50～89 kg,平均66 kg;身高165～180 cm,平均173 cm.均是在运动中跳起或着地时受伤,篮球6例,足球1例,跳高1例,跨栏1例.其中1例有Osgood-Schlatter病,2例受伤前有明显的胫骨结节区疼痛病史.髌韧带撕脱2例,无关节内损伤病例.按照Ogden和Ryu & Debenham改良分型:Ⅰ型1例,Ⅱ型2例,Ⅲ型4例,Ⅳ型2例.非手术治疗3例,手术治疗6例.非手术组均行手法复位管型石膏固定;手术组切开复位内固定治疗,其中空心螺钉固定3例,克氏针及螺钉固定2例,可吸收螺钉固定1例,同期行关节探查3例.两组均行石膏固定6周.随访骨折愈合、关节功能及畸形情况.结果 8例患儿获得随访,1例保守治疗的患儿失随访,随访时间6个月至5年6个月,平均27.5个月.根据Mosier等的标准对患儿肢体功能进行评估,结果均为优.2例有股四头肌萎缩,1例髌下感觉减退,无骨筋膜室综合症、膝反张、感染、关节屈曲障碍、再骨折、肢体不等长等并发症.结论对于青少年胫骨结节撕脱性骨折非移位或轻微移位骨折可以保守治疗,但要警惕骨筋膜间室综合症发生.移位性骨折行切开复位空心螺钉内固定,同时修复撕裂的髌韧带、骨膜町以达到满意的疗效.
목적 대청소년경골결절시탈성골절림상치료결과진행분석,병회고이왕문헌보고,총결해병적치료급예후.방법 회고성분석2003년1월지2008년6월간9례채용비수술화수술방법치료적경골결절시탈성골절환인,균위남성,년령12세10개월～16세3개월,평균년령14세7개월;체중50～89 kg,평균66 kg;신고165～180 cm,평균173 cm.균시재운동중도기혹착지시수상,람구6례,족구1례,도고1례,과란1례.기중1례유Osgood-Schlatter병,2례수상전유명현적경골결절구동통병사.빈인대시탈2례,무관절내손상병례.안조Ogden화Ryu & Debenham개량분형:Ⅰ형1례,Ⅱ형2례,Ⅲ형4례,Ⅳ형2례.비수술치료3례,수술치료6례.비수술조균행수법복위관형석고고정;수술조절개복위내고정치료,기중공심라정고정3례,극씨침급라정고정2례,가흡수라정고정1례,동기행관절탐사3례.량조균행석고고정6주.수방골절유합、관절공능급기형정황.결과 8례환인획득수방,1례보수치료적환인실수방,수방시간6개월지5년6개월,평균27.5개월.근거Mosier등적표준대환인지체공능진행평고,결과 균위우.2례유고사두기위축,1례빈하감각감퇴,무골근막실종합증、슬반장、감염、관절굴곡장애、재골절、지체불등장등병발증.결론 대우청소년경골결절시탈성골절비이위혹경미이위골절가이보수치료,단요경척골근막간실종합증발생.이위성골절행절개복위공심라정내고정,동시수복시렬적빈인대、골막정이체도만의적료효.
Objective To review the clinical outcome of tibial tubercle avulsion fracture in adolescents.Methods This was a retrospective analysis of a consecutive series of 9 children with tibial tubercle avulsion fracture managed in our institution between January 2003 and June 2008.All patients were boys,with an average age of 14.6 years(range 12.8-16.3).The average weight was 66 kg (range 50-89)and the average height was 173cm (range 165-180).The avulsion occurred after a jump or on landing 8 children-The fracture occurred during basketball (n=6),Soccer (n=1),High jump (n=1),hurdle jump (n=1).One was diagnosed with Osgood-Schlatter disease and two patients presented symptomatic ipsilateral or contralateral anterior tibial apophysitis before the accidents.There were three patellar ligament avulsion and no meniscal injury.According to the Ogden's and Ryu and Debenham's modified classification system,there were 1 type I (11%);2 type Ⅱ (22%);4 type Ⅲ(44%),2 type Ⅳ (22%) injuries.Three patients had close reduction under anesthesia and cvlinder cast immobilization.Six patients underwent open reduction and internal fixation,including 3 cancellous screws,2 Kirschner wires and screws,and 1 absorbable screws.Three patients underwent knee joint exploration.Cast immobilization was maintained for six weeks in both groups.The functional outcome was assessed at last follow-up.Results One patient was lost during follow-up.Eight patients were followed up for a mean of 27.5 months (range 6-66).The functional outcome was excellent in all patients according to the Mosier's scoring system for the motion function.Two of 8 patients had quadriceps atrophy,one had infrapatellar hypoesthesia.There were no compartment syndrome,deformity ol knee joint,nonunion,genu recurvatum,infection,refracture or leg length discrepancy.Conclusions Tibial tubercle avulsion with minimal displacement can be treated conservatively.The displaced fracture generally require open anatomic reduction and internal fixation.The outcome is generally good.