CAJ | 학술논문

目的：分析成骨不全症儿童下肢骨折经保守治疗后的远期结果及其并发症。方法回顾性对比分析患者的系列 X 线片，2001年9月至2014年7月，我科共收治1100例成骨不全症患者，其中 Sillence 分型 I 型376例，III 型320例，IV 型404例。其中就诊时已经出现骨骺闭合者437例。其中既往反复下肢骨折均采用保守治疗(牵引、夹板或者石膏固定)且 X 线片资料完整者45例，男30例，女15例，就诊时平均年龄17(13～34)岁。Sillence 分型：I 型2例，III 型20例，IV 型23例。分析患者的骨折次数、每次骨折的肢体固定时间，记录最终随访时的下肢功能、下肢骨骼的形态变化以及最终随访时的 X 线片表现。结果45例每次骨折均采用保守治疗，骨折后肢体固定平均时间为50(30～90)天，多数骨折可愈合，但30例假关节形成，27例骨骺早闭。X 线片显示反复骨折需要长时间牵引或者石膏固定，患肢制动、不负重超过6个月以上者，X 线片显示骨质疏松异常加重。X 线片总体表现骨骼纤细、髓腔封闭、关节膨大、皮质变薄、骨骼多平面弯曲畸形。最终随访时5%的患者完全卧床，30%需要轮椅，35%可以拐杖辅助下短距离行走，30%可自行行走，部分伴有步态异常。30%的病例因为矫形和内固定困难已无法进行任何骨科治疗。结论成骨不全症儿童下肢骨折虽然经保守治疗可以愈合，但反复骨折和保守治疗后其远期功能结果和 X 线片表现差，应及时行截骨矫形髓内固定以尽早恢复肢体的负重功能，从而避免骨骼发育受阻。
목적：분석성골불전증인동하지골절경보수치료후적원기결과급기병발증。방법회고성대비분석환자적계렬 X 선편，2001년9월지2014년7월，아과공수치1100례성골불전증환자，기중 Sillence 분형 I 형376례，III 형320례，IV 형404례。기중취진시이경출현골후폐합자437례。기중기왕반복하지골절균채용보수치료(견인、협판혹자석고고정)차 X 선편자료완정자45례，남30례，녀15례，취진시평균년령17(13～34)세。Sillence 분형：I 형2례，III 형20례，IV 형23례。분석환자적골절차수、매차골절적지체고정시간，기록최종수방시적하지공능、하지골격적형태변화이급최종수방시적 X 선편표현。결과45례매차골절균채용보수치료，골절후지체고정평균시간위50(30～90)천，다수골절가유합，단30례가관절형성，27례골후조폐。X 선편현시반복골절수요장시간견인혹자석고고정，환지제동、불부중초과6개월이상자，X 선편현시골질소송이상가중。X 선편총체표현골격섬세、수강봉폐、관절팽대、피질변박、골격다평면만곡기형。최종수방시5%적환자완전와상，30%수요륜의，35%가이괴장보조하단거리행주，30%가자행행주，부분반유보태이상。30%적병례인위교형화내고정곤난이무법진행임하골과치료。결론성골불전증인동하지골절수연경보수치료가이유합，단반복골절화보수치료후기원기공능결과화 X 선편표현차，응급시행절골교형수내고정이진조회복지체적부중공능，종이피면골격발육수조。
Objective To analyze long term results and complications of conservative treatment for lower leg fractures in children with osteogenesis imperfecta.Methods The series X-ray iflm of 1100 patients admitted in our hospital from September 2001 to July 2014 were analyzed retrospectively. According to Sillence classiifcation, there were 376 cases of type I, 320 cases of type III, and 404 cases of type IV. Epiphyseal closure occurred in 437 cases, among which 45 cases ( 30 males and 15 females ) had long term series of X -ray iflm and were treated conservatively for the recurrent fractures of the lower legs ( e.g. traction, splints, spica cast ). The average age was 17 years old ( range: 13-34 years ). Sillence classification: type I 2 cases, type III 20 cases, type IV 23 case. The number of fractures and the immobilization time of each fracture were analyzed. Functions of the lower leg, the alignment and the radiological results of the femur and the tibia at the latest follow up were recorded.Results Recurrent fractures were treated by conservative method in 45 cases. The mean period of immobilization was 50 days ( range: 30-90 days ). Most fractures healed, while 30 cases have pseudarthrosis and 27 cases showed premature epiphyseal closure. For those legs immobilized by traction or cast without any weight bearing and the time of immobilization was longer than 6 months due to recurrent fractures, the X-ray iflm showed progressive process of osteoporosis. Radiologically, the bone became slim, the medullary canal closed, the joint swelled compared with the slim diaphysis. If the medullary canal existed, the cotex bone was usually thin and the multiple level deformity was common. At the latest follow up, 5% patients were completely bedridden; 30% needed wheelchair; 35% could walk in short distance with the aid of crutches; 30% could walk independently; although some of them had abnormal gait. Unfortunately, 30% cases could not receive any orthopedic procedures because the bone was too slim to be ifxed.Conclusions Although the fracture of the lower leg in children with osteogenesis imperfecta usually can heal by conservative treatment, recurrent fracture and conservative treatment will lead to bad long term functional and radiological results. Timely osteotomy and intramedullary pin ifxation are recommended to restore the weight-bearing function to avoid adverse effects on bone growth.