CAJ | 학술논문

目的探讨青少年胫骨远端三平面骨折的诊断、治疗和预后. 方法 2005年2月至2008年10月收治胫骨远端三平面骨折11例,男8例,女3例;年龄12.5～15.3岁,平均13.8岁.右踝9例,左踝2例.X线片示11例患者均为外侧二部分关节内三平面骨折,其中2例伴腓骨骨折.采用闭合复位石膏固定6例,切开复位内固定5例. 结果 11例患者获平均24个月(6～36个月)随访.踝关节功能采用美国足踝外科协会(AOFAS)踝与后足功能评分标准进行评估:优6例,良3例,一般2例.手术患者中2例(预后一般的病例)出现感染及伤口周围皮肤局部坏死. 结论胫骨远端三平面骨折是青少年踝关节所特有的复杂骨折,其骨折形态由损伤时骨骺骨化的程度和所受暴力的大小所决定.术前CT多维重建是获得准确诊断,选择合理入路的前提.如果骨折移位 >2 mm或保守治疗不能达到解剖复位或复位无法维持,建议切开复位内固定.理想预后的基础是解剖复位.
목적 탐토청소년경골원단삼평면골절적진단、치료화예후. 방법 2005년2월지2008년10월수치경골원단삼평면골절11례,남8례,녀3례;년령12.5～15.3세,평균13.8세.우과9례,좌과2례.X선편시11례환자균위외측이부분관절내삼평면골절,기중2례반비골골절.채용폐합복위석고고정6례,절개복위내고정5례. 결과 11례환자획평균24개월(6～36개월)수방.과관절공능채용미국족과외과협회(AOFAS)과여후족공능평분표준진행평고:우6례,량3례,일반2례.수술환자중2례(예후일반적병례)출현감염급상구주위피부국부배사. 결론 경골원단삼평면골절시청소년과관절소특유적복잡골절,기골절형태유손상시골후골화적정도화소수폭력적대소소결정.술전CT다유중건시획득준학진단,선택합리입로적전제.여과골절이위 >2 mm혹보수치료불능체도해부복위혹복위무법유지,건의절개복위내고정.이상예후적기출시해부복위.
Objective To investigate the diagnosis, treatment and prognosis of the triplane fractures of distal tibia in the teenagers. Methods From February 2005 to October 2008, 11 young patients with triplane fractures of the distal tibia were treated in our department. They were 8 boys and 3 girls, with an average age of 13.8 (12.5 to 15.3) years. The right ankle was involved in 9 cases and the left in 2. X-ray examination revealed lateral two-fragment tripiane fractures in all the 11 patients, 2 of whom presented with fibular fractures. Six patients were treated with closed reduction and plaster immobilization, while 5 with open reduction and internal fixation (ORIF). Results All the 11 patients had a mean follow-up of 24 (range, 6 to 36) months. The American Orthopaedic Foot & Ankle Society(AOFAS) ankle and hindfoot scale revealed 6 excellent (90 to 100 points) patients, 3 good (75 to 89 points) ones and 2 fair (50 to 74 points) ones. Of the 5 patients treated surgically, 2 experienced superficial infection and partial skin necrosis around the incisions. Conclusions The severity of triplane fracture of the distal tibia in teenagers de-pends on the degree of physis ossification and the magnitude of injury force. Preoperative CT scan and re-construction are essential to an accurate diagnosis and selection of operative approach. ORIF is recommended when the fracture displacement is over 3mm, or when anatomical reduction cannot be achieved and maintained with close treatments. Anatomical reduction is the key to good prognosis.