摘要目的 探讨外固定架结合有限内固定治疗累及干骺端的青少年胫骨远端骨折的疗效.方法 选择北大医疗鲁中医院2013年2月至2017年6月收治的采用外固定架结合有限内固定微创治疗的累及干骺端的青少年胫骨远端骨折患者18例为研究对象,均为闭合性骨折,按Salter-Harris分型:Ⅱ型8例,Ⅲ型8例,Ⅳ型2例.观察术后骨折愈合时间,患肢完全负重时间,踝关节功能评分情况,术后切口皮肤、深部组织及钉道感染等并发症情况.结果 18例患者获得术后12～24个月随访,平均16个月,术后骨折愈合时间为(8.4±3.2)周,患肢完全负重时间为(8.8±2.2)周,踝关节功能评分按照Kofoed评分:术后6周随访Kofoed评分为(86.6±6.8)分,优15例,良3例,优良率为100％,1例患者术后1周钉道渗出,拆除外固定架后钉道愈合,无其他切口及深部感染等并发症发生.结论 对于合并有骨骺损伤的青少年胫骨远端骨折,采用外固定架结合有限内固定手术治疗,避免开放性手术造成骨折端血运破坏,具有小切口、骨折愈合快、并发症少、踝关节功能恢复好等优点,有良好的临床治疗效果.

abstractsObjective To evaluate the clinical indications,complications and curative effects of external fixation combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysis.Methods From February 2013 to June 2017,18 adolescent patients of distal tibial fracture involving stem epiphyseal in Luzhong Hospital of Beida Care were treated with external fixator combined with limited internal fixation.All 18 cases were closed fractures,according to Salter-Harris classification:type Ⅱ 8 cases,type Ⅲ 8 cases,type Ⅳ 2 cases.The fracture healing time,postoperative patients with limb full weight-bearing time,postoperative ankle function grading,postoperative incision of the skin,deep tissue and nail complications such as infection were observed.Results All patients received postoperative 12 to 24 months follow-up,with average of 16 months,the average postoperative fracture healing time was (8.4± 3.2)weeks,the full load time of affected limb after operation was average (8.8 ± 2.2) weeks,the ankle joint function score according to Kofoed score:6 weeks after operation,Kofoed score was (86.6 ± 6.8) points,excellent in 15 cases,good in 3 cases,and the excellent and good rate was 100％,1 case with nail way out at postoperative 1 week,after the demolition of external fixator nail healed,no other blade and deep infection and other complications occurred.Conclusion The external fixation combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysic can avoid fracture end blood supply damage caused by open surgery,it is quick with small incision,fracture healing,fewer complications,and the advantages of ankle joint function restore is good,has good clinical therapeutic effect.