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目的探讨关节镜下双空心加压螺钉内固定治疗青少年股骨内髁Salter-Harris Ⅲ型骨折的临床疗效。方法笔者自2006-09—2014-08诊治23例青少年股骨内髁Salter-Harris Ⅲ型骨折,在关节镜下清理复位,在骺板远端用2枚4.5 mm的空心加压螺钉固定骨折。结果23例获得随访平均15.7(12~36)个月,手术时间为(28.92±5.04)min,所有的骨折解剖复位,术后3个月获骨性愈合,术后1年肢体长度较对侧无变化。Tegar评分术前(3.00±1.65)分,末次随访为(8.00±1.24)分;Lyshlom评分术前(25.43±10.04)分,末次随访为(92.00±3.91)分,末次随访Tegar评分、Lysholm评分较术前有较大改善,差异有统计学意义(t=-26.830,P<0.001;t=-11.218,P<0.001)。末次随访膝关节主动活动度:患侧活动度为(125.65±4.28)°,健侧活动度为(126.48±4.12)°,患侧与健侧比较差异无统计学意义(t=-0.890,P=0.445)。本组皆无感染、关节纤维化、下肢深静脉血栓形成。结论关节镜下双空心加压螺钉能最大程度解剖复位并坚强固定分离的股骨内髁和关节面,具有优良的短期临床效果。
Objective To investigate the clinical effect of arthroscopic double hollow compression screw internal fixation for treatment of adolescent femoral conteral Salter-Harris Ⅲ fracture. Methods From 2006-09-2014-08, the author diagnosed and treated 23 cases of adolescent femoral condyles Salter-Harris type Ⅲ fractures under arthroscopy. Two 4.5 mm cannulated screws were used to fix the fracture in the distal epiphyseal plate. Results All the 23 cases were followed up for an average of 15.7 (12-36) months and the operation time was (28.92 ± 5.04) min. All the fractures were anatomically restored and got bony union at 3 months after operation. The limb length at 1 year after operation was longer than that on the contralateral side No change. Tegar score was (3.00 ± 1.65) minutes before the last follow-up (8.00 ± 1.24); Lyshlom score was (25.43 ± 10.04) minutes before the last follow-up (92.00 ± 3.91) There was a significant improvement before surgery, the difference was statistically significant (t = -26.830, P <0.001; t = -11.218, P <0.001). The active knee mobility was (125.65 ± 4.28) ° at the time of follow-up and (126.48 ± 4.12) ° at the contralateral side, with no significant difference between the ipsilateral and contralateral sides (t = -0.890, P = 0.445). No infection in this group, joint fibrosis, deep venous thrombosis. Conclusion Arthroscopic double hollow compression screw can maximally anatomize and fix the separated femoral condyle and articular surface, which has excellent short-term clinical effect.