PURPOSE:Long-term nonunion of the lateral humeral condyle (LHC) can result in progressive cubitus valgus, elbow pain, instability, and delayed ulnar nerve palsy. Various techniques have been proposed for correction, each with its own advantages and disadvantages. The purpose of this study was to introduce a lateral open wedge osteotomy (LOWO) procedure combined with in situ osteosynthesis of nonunited LHC for the treatment of long-term LHC nonunion with cubitus valgus deformity. METHODS:We evaluated 18 pediatric patients who had a cubitus valgus deformity greater than 10 degrees after nonunion of the LHC for more than 2 years. The LHC was fixed in situ with 1 or 2 cancellous screws, and the LOWO was fixed with a locking plate. All patients underwent clinical and radiologic evaluation, and the pre- and postoperative carrying angle (CA), range of motion (ROM), and Mayo elbow performance score (MEPS) were analyzed. RESULTS:Eighteen patients, with a mean age of 9.9 ± 3.9 years, underwent treatment for LHC nonunion and cubitus valgus deformity after a mean interval of 61.6 ± 24.1 months from the initial injury. The mean follow-up period was 57.6 ± 22.8 months. Union of the LHC and LOWO was achieved in all patients. The mean CA decreased significantly from 31.6 ± 4.8 degrees before surgery to 10.4 ± 2.2 degrees after surgery (P<0.001). Surgery did not decrease elbow range of motion (P=0.202). The mean MEPS increased significantly from a preoperative value of 55 ± 4.9 to a postoperative value of 91.1 ± 5.6 (P<0.001). No significant complications were observed. CONCLUSIONS:LOWO combined with in situ fixation of nonunited LHC is an effective approach for treating long-term LHC nonunion associated with cubitus valgus deformity.

Lateral condylar (LC) and olecranon (OC) fractures occurring concurrently on one side are rare phenomena with limited scientific literature. Our study aims to evaluate the radiologic, clinical, and functional consequences of lateral to medial injury of the elbow (LAMEINE) in pediatric patients, simultaneously comparing with lateral to medial diagonal injury of the elbow (MELAINE). Eighteen males and 10 females were diagnosed with LAMEINE. The average age at the time of injury was 3.8 ± 2.3 years (range, 1–9). Out of the 28 fractures, 19 (67.9%) occurred on the left side and nine (32.1%) on the right side. The OC fractures were classified according to the Weiss system, two being type I, 17 type II, and nine type III fractures. Based on the specific case characteristics, the OC fractures were further subdivided into five types corresponding to two types of AO classification: 24 (85.7%) cases of AO 21u-M/2. 1 incomplete fractures [3 type I (10.7%), 16 type II (57.1%), and five type III fractures (17.9%)], and four (14.3%) cases of AO 21u-M/3.1 complete simple fractures [2 type IV (7.1%) and two type V fractures (7.1%)]. All patients underwent surgical intervention. Their clinical and functional outcomes were evaluated using the carrying angle (CA) and elbow performance score (EPS). These results were then compared with those of our MELAINE patients. All patients were followed up for 42.9 ± 23.5 months (range, 15–88). Radiographs indicated that all fractures healed in 5.9 ± 1.4 weeks (range, 4–10). At the last follow-up, the CA and EPS of the injured side were 11.3° ± 2.8° and 97.7 ± 3.7, respectively. All patients had favorable outcomes: 27 patients (96.4%) had excellent EPS, and only one patient (3.6%) had good EPS. The LAMEINE group displayed lower age, displacement, incidence of elbow dislocation, and CA than the MELAINE group ( P < 0.05). Although relatively rare, LAMEINE should not be neglected. Surgical treatment aims to stabilize the elbow and avoid varus deformity. With appropriate diagnosis and treatment, good clinical and radiographic outcomes can be achieved for both patterns of ‘diagonal lesions’ of the pediatric elbow. Level of evidence: III.

Medial humeral condyle (MHC) fractures are easily overlooked in young patients. This can lead to delayed or incorrect diagnosis, resulting in delayed treatment, which is often associated with complications such as nonunion, osteonecrosis, fishtail deformity, and cubitus varus. The purpose of this study is to evaluate the clinical and radiographic outcomes in a cohort of paediatric patients who underwent delayed surgery for an untreated MHC fracture. From January 2017 to December 2022, we conducted a retrospective study of paediatric patients who underwent delayed treatment for a MHC fracture. In all cases, the initial diagnosis was incorrect and surgery was performed at least one week after injury. Patients were divided into two groups based on the time between trauma and surgery: Group 1 consisted of individuals who underwent early delayed treatment within seven to 30 days of injury, while Group 2 consisted of those who underwent late delayed treatment more than one month after injury. Elbow function was assessed using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM). The related literature was also reviewed (1970–2023). We enrolled 12 patients (7 boys, 5 girls); the average age at the time of surgery was 7.7 years (range, 2–14 years). Six patients underwent early delayed treatment (Group 1) while another six underwent late delayed treatment (Group 2). The mean time from injury to surgery was 17.7 days (range, 7–30 days) and 33.3 months (range, 70 days–9 years) in Groups 1 and 2, respectively. Open reduction and internal fixation were performed via a medial approach in 11 patients, while one patient underwent closing wedge osteotomy and internal fixation to correct cubitus varus deformity. The mean duration of follow-up was 39.4 months (range, 8–60 months). The average MEPS score was 98.3 in Group 1 (range, 95–100) and 94.2 in Group 2 (range, 85–100; P = 0.21). The following postoperative complications were recorded: heterotopic ossification (n = 2), fishtail deformity (n = 1), MHC necrosis (n = 1), and reduction of elbow ROM (n = 1); one complication occurred in Group 1 and five occurred in Group 2 (P = 0.18). We reviewed nine related studies (n = 14 patients). Diagnosis of MHC fractures can be challenging in paediatric patients, especially in younger individuals with incompletely ossified trochlea. Patients requiring surgery for delayed MHC fractures with an unossified trochlea should undergo ORIF to prevent progressive varus deformity. On the other hand, in patients with cubitus varus and an already ossified trochlea, distal humeral osteotomy should be considered instead of ORIF. This will minimize the potential negative impact on joint mobility.

Objective:To investigate the biomechanical properties of a new pediatric femoral neck system in the fixation of pediatric femoral neck fractures with a free fracture fragment.Methods:Ten Sawbones model bones were randomly divided into 2 even groups ( n=5), all of which were made into Delbet Type Ⅱ femoral neck fractures with a Pauwels angle of 70°. A free bone block was removed from the bottom at the proximal end of the fracture to simulate a femoral neck fracture with a free fragment. Group A were fixed with traditional inverted triangle cannulated screws, and group B with a new pediatric femoral neck system. After the 2 groups of specimens were placed on a biomechanical testing machine, each specimen was subjected to a static axial compression test, an anti-torsion test and a cyclic load test in turn. The biomechanical results were compared between groups A and B in aspects of axial compression stiffness, torsional stiffness and maximum displacement difference. Results:The axial compression stiffness [(321.718±5.770) N/mm] and torsional rigidity [(1.448±0.079) N·m/°] in group B were significantly higher than those in group A [(266.722±4.788) N/mm and (1.282±0.023) N·m/°] ( P<0.05). The maximum displacement difference in the cyclic load test in group B [(0.063±0.038) mm] was also significantly smaller than that in group A [(0.117±0.056) mm] ( P<0.05). Conclusion:In fixation of pediatric femoral neck fractures with a free fracture fragment, the new pediatric femoral neck system can lead to better biomechanical stability than the traditional inverted triangle cannulated screws.

BACKGROUND:Osteofibrous dysplasia (OFD) is a rare non neoplastic, self-limited intracortical fibro-osseous lesion that most commonly affects the diaphysis of the tibia and fibula of children, the best treatment is still debated. Therefore we performed a retrospective study in children mostly under 10 years old with OFD aiming to determine whether early surgery is necessary and which is the best treatment.HYPOTHESIS:Symptomatic OFD lesions should be treated proactively, and appropriate treatment can achieve favorable outcome.METHODS:We retrospectively reviewed 23 patients with OFD of the tibia (n=22) and fibula. Management varied according to the severity of symptoms (deformity, pain or pathological fracture) and the extent of the lesion. Cases were divided into four groups (Gr.): Gr. 1: observation (n=4); Gr. 2: curettage and allograft (n=6); Gr. 3: curettage, allograft and elastic stable intramedullary nailing (ESIN) fixation (n=9); Gr. 4: extra-periosteal resection and bone transport (n=5). One patient received two different treatments successively (23 patients and 24 cases). All patients had regular clinical and radiographic follow-up to assess bone consolidation and complications.RESULTS:In Gr. 1, four asymptomatic patients underwent observation after open biopsy. Gr. 4 had the lowest local recurrence rate: 0 cases (0%) vs. 4 (66.7%; Gr. 2) vs. 1 (11.1%; Gr. 3) (p=0.002), incidence of deformity: 0 case (0%) vs. 0 (0%; Gr. 2) vs. 3 (50%; Gr. 3) (p=0.023), and pathological fracture: 0 case (0%) vs. 0 (0%; Gr. 2) vs. 1 (16.7%; Gr. 3) (p=0.006), although the consolidation time was longer: 6.8 vs. 2 (Gr. 2) vs. 2.7 months (Gr. 3) (p=0.017) and the rate of complication was higher than those of Gr. 2 and Gr. 3 (p<0.05). Gr. 3 had a lower local recurrence rate: 1 case (11.1%) vs. 4 cases (66.7%) (p=0.002), incidence of deformity: 0 case (0%) vs. 3 cases (50%) (p=0.023), and pathological fracture: 0 case vs. 1 case (16.7%) (p=0.006) than Gr. 2.DISCUSSION:Open biopsy is an important step in the management of patients with imaging suggestive of OFD in order to rule out Adamantinoma and other bone tumors or infection. Observation should be reserved for asymptomatic patients, while surgical treatment is indicated in patients with persistent pain, pathological fracture or significant deformity of the tibia. ESIN is a valid option to preserve the anatomical axis of the tibia in symptomatic patients with lesions of limited size; large circumferential lesions or recurrence can be managed by extra-periosteal resection and bone transport, although the complication rate can be relatively high.LEVEL OF EVIDENCE:III; case control study.

Purpose: The simultaneous and ipsilateral occurrence of medial epicondylar and radial neck fractures is rare. This study evaluated the clinical and radiological outcomes of medial to lateral diagonal injury of the elbow (MELAINE). Methods: Six males and 6 females were diagnosed with MELAINE (left: 10, 83.3%; right: 2, 16.7%). Medial epicondylar and radial neck fractures were classified according to Papavasiliou’s classification (seven type II, two type III, three type IV) and Judet’s classification (three type I, four type II and five type III), respectively. All patients underwent surgery. The carrying angle, range of motion, and Kim et al. Elbow Performance Score were used to evaluate clinical and functional outcomes; related complications were recorded. Results: Mean age at injury and mean follow-up were 11.1 ± 2.5 (range, 6–14) and 40 ± 25.6 months (range, 13–90), respectively. All fractures consolidated in 6.3 ± 1.2 weeks on average (4–9). Outcomes were good (n = 1; 8.3%) to excellent (n = 11; 91.7%). The carrying angle of the injured and uninjured side was 15.5°± 2.6° and 14.7°± 2°, respectively (p = 0.218). The range of motion of elbow flexion-extension and forearm pronation-supination of the injured side was 144.2°± 10.4°, 4.6°± 5.4°, 76.7°± 9.1°, 80.4°± 9.2°, respectively, with no significant differences from the healthy side (p > 0.05). The Elbow Performance Score of the injured and uninjured side was 96.3 ± 5.3 and 98.8 ± 2.3, respectively (p = 0.139). No cases of infection, cubitus valgus, stiffness, or instability were recorded. Conclusion: Although uncommon, MELAINE should not be neglected. Surgery aims to stabilize the elbow and avoid valgus deformity. If diagnosed and treated, clinical and radiological results are excellent in most cases.

T-condylar (T-C) fractures of the distal humerus are rare in children. There is no accepted treatment for such an injury, and there is a lack of reports evaluating the outcome of T-C fractures treated by closed reduction and percutaneous fixation. The aim of this study was to evaluate the feasibility of closed reduction and percutaneous K-wire and screw (CRPKS) fixation in patients with type II and III T-C fractures according to the Toniolo-Wilkins classification modified by Canavese et al. (TWC classification). The clinical data of 12 consecutive patients (8 males, 4 females) who were younger than 14 years of age and who had a T-C fracture that was managed by CRPKS were retrospectively evaluated. Fractures were classified according to the TWC classification. The baseline information of the patients, carrying angle (CA) and Mayo Elbow Performance Score (MEPS) were used to evaluate clinical and functional outcomes; related complications were recorded. Statistical analysis was performed. The mean age at the time of injury was 11.6 ± 1.8 years (range, 8–14). The time from injury to surgical treatment was 1.5 ± 1.0 days (range, 0–3), and the mean follow-up duration was 33.7 ± 12.3 months (range, 18–61). Surgery lasted 45.7 ± 7.6 min on average (range, 35–58). All fractures healed in 4.9 ± 1.0 weeks on average (range, 4–7). At the last follow-up visit, the CA was 12.6° ± 5.8° on the injured side and 13.8° ± 1.8° on the uninjured side (p=0.432). The MEPS was 100 (95, 100) on the injured side and 100 (100, 100) on the uninjured side (p=0.194). Three complications were recorded. Good functional and radiological outcomes can be expected in pediatric patients with type II and III T-C fractures treated by CRPKS. The technique is relatively simple to perform and has a lower rate of complications.

Objective:To explore the diagnosis and treatment of humeral medial epicondyle fracture combined with radial neck fracture in children and adolescents.Methods:The clinical data were retro-spectively analyzed of the 12 pediatric patients with fractures of the humeral medial epicondyle plus the radial neck who had been admitted from February 2015 to August 2021 to Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. There were 6 males and 6 females, with an age of (11.1 ± 2.5) years. According to the Papavasiliou classification, the humeral medial epicondyle fractures were type Ⅱ in 7 cases, type Ⅲ in 2 cases and type Ⅳ in 3 cases; according to the Judet classification, the radial neck fractures were type Ⅰ in 3 cases, type Ⅱ in 4 cases and type Ⅲ in 5 cases. Two Judet-Ⅰ radial neck fractures were missed by X-ray exam-ination but diagnosed by CT examination. Of the humeral medial epicondylar fractures, 9 were treated by open reduction and hollow screwing and 3 by closed reduction and Kirschner wiring. Of the radial neck fractures, 8 were treated by closed reduction and elastic intramedullary nailing and 4 conservatively. Fracture healing was followed up by postoperative radiographs. At the last follow-up, the carrying angles were measured, Kim Elbow Function Score (KEPS) was used to evaluate the functional recovery of the injured limb, and related complications were recorded.Results:All the 12 patients were followed up for (40.0±25.6) months. Fractures headed after (6.3±1.2) weeks. At the last follow-up, the carrying angle was 15.5°±2.6° on the injured side and 14.7°±2.0° on the healthy side, showing no significant difference ( P>0.05); KEPS was (96.3±5.3) points on the injured side and (98.8±2.3) points on the healthy side, showing no significant difference either ( P>0.05). No incision infection, bone nonunion, elbow valgus, joint stiffness or other complications were found; the postoperative elbow stability recovered well. Conclusions:As the fracture of the humeral medial epicondyle combined with the radial neck fracture is a special type of injury of straightened elbow during valgus stress in children and adolescents, it is likely to be missed in diagnosis. The goal of treatment is good functional recovery by restoring the articular match and elbow stability.

Objective To investigate the regulatory effect of microRNA-335-5p on human chondrocytes WISP3 and the pathogenesis of miR-335-5p in OA. Methods.Removal of articular cartilage from traumatic patients, separating and extracting chondrocytes, the expression level of WISP3 in each group was detected by qRT-PCR and Western Blotting after transfection of microRNA-335-5p mimics, mimics NC, inhibitor, inhibitor NC. Results.Compared with the negative control group, microRNA-335-5p overexpression down-regulated mRNA and protein expression levels of WISP3, on the contrary, the low expression of microRNA-335-5p up-regulated the expression of mRNA and protein in WISP3. Conclusion.MicroRNA-335-5p can inhibit mRNA transcription and protein synthesis of WISP3, microRNA-335-5p plays a potential role in the pathogenesis and development of OA by regulating WISP3 in chondrocytes.

背景:骨碎补的有效成分柚皮苷具有补肝肾强筋骨的传统功效,能增加骨痂厚度,提高骨折愈合质量.目的:探究载中药骨碎补有效成分柚皮苷壳聚糖/羟基磷灰石复合支架的骨传导和骨诱导性能.方法:将一定钙磷比的羟基磷灰石前体液与含柚皮苷的壳聚糖溶液在碱性条件下原位结晶、冷冻干燥,获得柚皮苷-壳聚糖/羟基磷灰石多孔支架.将15只成年SD大鼠随机分成空白组(n=5)、对照组(n=5)和实验组(n=5),建立直径5 mm颅骨骨缺损模型,空白组未填充生物材料,对照组填充壳聚糖/羟基磷灰石支架,实验组填充柚皮苷-壳聚糖/羟基磷灰石复合支架.术后4周取材,CT扫描观察颅骨修复情况,苏木精-伊红染色观察颅骨修复的形态学,骨形态发生蛋白2和血管内皮生长因子免疫组化染色后观察缺损区域局部成骨活性因子的表达.结果 与结论:①CT扫描显示,空白组大鼠颅骨未见明显骨生成,仅在缺损边缘可见少量新生骨;对照组于缺损孔隙可见新生骨形成,新生骨较少;实验组骨缺损修复良好,新生骨组织与缺损孔隙周围颅骨密度相似,大面积新生骨广泛填充了缺损孔隙.②苏木精-伊红染色显示,空白组缺损区填充以稀薄的疏松网状纤维组织,可见大量炎性反应病灶,仅在缺损边缘有少量新骨生成;对照组与实验组缺损区均可见支架材料残留,新生骨小梁及成骨细胞成簇分布于支架孔隙及缺损区边缘,周围伴有大量的毛细血管,其中以实验组表现出更强的新骨爬行替代能力.③免疫组化染色显示,实验组局部成骨活性因子骨形态发生蛋白2和血管内皮生长因子的表达高于对照组、空白组(P<0.05).④结果表明,柚皮苷-壳聚糖/羟基磷灰石复合支架可为骨缺损修复提供必要的载体,柚皮苷可创造局部成骨微环境、加速新生骨组织的生长,具有良好的骨修复性能.

Purpose Unstable femoral shaft fractures (UFSFs) in children aged 5–11 years remain challenging due to their intrinsic instability. The aim of this study was to evaluate the clinical and radiographic outcomes of UFSF in children aged 5 to 11 years managed by the combined use of ESIN and temporary EF. Methods Children with UFSF (long oblique and comminuted) treated by ESIN and temporary EF were retrospectively reviewed. Sex, age at injury, side involved, type of fracture, presence or absence of associated lesions or neurovascular complications, type of treatment, time from trauma to surgery, duration of surgery, radiation exposure and length of postoperative immobilization were collected from the medical charts. Radiological and functional outcomes were evaluated according to Beaty's and Flynn's criteria, respectively. Results A total of 28 consecutive patients with closed or open (Gustilo type I or II) UFSF were reviewed (18 boys and 10 girls). The mean age at injury was 8.7 ± 1.6 years (range, 5–11); the average weight was 38.1 ± 7.6 kg (range, 26–55). The mean hospital stay was 3.7 ± 1.4 days (range, 2–7), and the mean time to EF and ESIN removal was 6.5 ± 1.1 weeks (range, 4–8) and 9.4 ± 1.6 months (range, 6–12), respectively. Twenty-seven out of 28 patients had excellent radiographic outcomes according to Beaty's criteria, and 24/28 had excellent functional outcomes according to Flynn's criteria. Overall, 4 complications (14.3%) were recorded. No statistically significant correlation was found between complication rates and sex, age, weight or fracture characteristics (P < 0.05). Conclusions The combined use of ESIN and temporary EF provides good clinical and radiological outcomes in children with UFSF aged between 5 and 11 years, with a reduced complication rate.

Background and Objectives: The femoral neck system (FNS) is a new minimally invasive internal fixation system for femoral neck fractures (FNFs), but its use has not been reported in adolescents. The aim of this study was to compare the clinical and radiographic outcomes of displaced FNF in adolescents treated with FNS or a cannulated compression screw (CCS). Materials and Methods: A retrospective study of 58 consecutive patients with displaced FNF treated surgically was performed; overall, 28 patients underwent FNS and 30 CCS fixation. Sex, age at injury, type of fracture, associated lesions, duration of surgery, radiation exposure, and blood loss were collected from the hospital database. The clinical and radiographic results, as well as complications, were recorded and compared. Results: The patients were followed up for 16.4 ± 3.1 months on average after index surgery (range, 12 to 24). Consolidation time among patients treated with FNS was significantly lower than those managed by CCS (p = 0.000). The functional scores of patients treated with FNS were significantly higher than those managed by CCS (p = 0.030). Unplanned hardware removal in patients treated with FNS was significantly lower than in those managed by CCS (p = 0.024). Conclusions: FNS has a lower complication rate and better functional outcome than CCS. It may be a good alternative to treat femoral neck fractures in adolescents.

目的:介绍关节造影术在儿童拇指三角骺畸形诊治中的应用，并总结其临床疗效。方法:自2016年6月至2019年6月我院共收治13例(15侧)拇指三角骺畸形患儿，男5例，女7例；年龄18~42个月，平均28个月。采用指间关节造影辅助诊断，并根据造影后关节线形态设计截骨线及截骨角度，均采用三角骺内闭合楔形截骨术。结果:所有患儿均获得随访，平均20个月，远节指骨尺偏角由术前平均32°(18°~52°)矫正至平均10°(5°~21°)，指间关节活动度由术前平均78°(65°~90°)保留仍有平均70°(45°~90°)。有1侧截骨术后克氏针松动导致远节指骨尺偏21°，有残留畸形。有1侧术后虽然外观良好，但指间关节功能较差(屈伸活动度45°)。根据Tada评分标准：优13侧，良2侧。没有发现骨骺板损伤的迹象，没有出现指间关节炎的表现。结论:关节造影能辅助诊断三角骺畸形，清晰显示关节线并辅助制定截骨方案，方法简单、有效，值得推广。三角骺内闭合楔形截骨可恢复正常解剖形态，不产生轴偏畸形及指间关节炎，疗效良好。

Objective:To evaluate the ultrasonography-guided percutaneous leverage reduction in the treatment of pediatric radial neck fractures.Methods:From May 2016 to May 2018, 42 patients with Judet Ⅲ or Ⅳ radial neck fracture were treated at Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. They were 15 boys and 27 girls, aged from 3 to 12 years. All of them were treated by percutaneous leverage reduction and Métaizeau technique. The operative procedures were guided by ultrasonography in 20 cases and by C-arm fluoroscopy in 22 cases. Postoperative evaluation was based on Métaizeau imaging criteria, Tibone and Stoltz functional criteria; complications such as radial nerve injury were recorded.Results:There were no statistically significant differences between the ultrasonography-guided group and the fluoroscopy-guided group in preoperative general data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in terms of Métaizeau imaging, Tibone or Stoltz functional scores ( P>0.05). The frequency of fluoroscopy was (2.7±0.6) times for the ultrasonography group and (14.6±3.4) times for the fluoroscopy group while the operation time averaged (25.8±5.9) min for the former and (38.1±9.2) min for the latter, showing significant differences ( P<0.05). No postoperative complications were observed in the ultrasonography group while 4 cases of radial nerve injury in the fluoroscopy group, also showing significant difference between the 2 groups ( P< 0.05). Conclusion:Ultrasonography-guided percutaneous leverage reduction is a suitable surgical treatment of radial neck fracture in children, because it is simple, effective and safe.

La dysplasie ostéofibreuse (OFD) est une lésion fibro-osseuse intracorticale bénigne qui touche les plus souvent la diaphyse du tibia et de la fibula de l’enfant, et dont le meilleur traitement n’a pas encore été déterminé. Nous avons réalisé une étude rétrospective chez les enfants de moins de 10 ans avec OFD du tibia ou de la fibula pour déterminer si la chirurgie précoce est indiquée, et quelle est la meilleure option chirurgicale. Les lésions symptomatiques doivent être traitées de façon proactive, et un traitement approprié assure des bons résultats. Nous avons analysé rétrospectivement 21 enfants avec OFD du tibia (n = 22) et de la fibula (n = 1). Le traitement a été adapté en fonction de la gravité des symptômes (déformation, douleur ou fracture pathologique) et de la taille de la lésion. Les patients ont été divisés en quatre groupes (Gr.): Gr. 1 : observation (n = 4) ; Gr. 2 : curettage et allograft (n = 6) ; Gr. 3 : curettage, allograft et enclouage centromédullaire élastique stable (ESIN) (n = 9) ; Gr. 4 : résection extrapériostée et transfert osseux (n = 5) ; un patient a été traité avec deux techniques (24 procédures au total). Tous les patients ont bénéficié d’un suivi radioclinique régulier afin d’évaluer la consolidation osseuse et le taux de complications. Les quatre patients asymptomatiques du Gr. 1, avec OFD confirmée à la biopsie, ont été observés. Le Gr. 4 avait le taux le plus bas de récidive locale : 0 cas (0 %) vs 4 (66,7 % ; Gr. 2) vs 1 (11,1 % ; Gr. 3) (p = 0,002), de déformation : 0 cas (0 %) vs 0 (0 % ; Gr. 2) vs 3 (50 % ; Gr. 3) (p = 0,023), et de fracture pathologique : 0 cas (0 %) vs 0 (0 % ; Gr. 2) vs 1 (16,7 % ; Gr. 3) (p = 0,006) ; néanmoins, le temps de consolidation : 6,8 vs 2 (Gr. 2) vs 2,7 mois (Gr. 3) (p = 0,017) et le taux de complications étaient plus élevés que dans le Gr. 2 et le Gr. 3 (p < 0,05). Par rapport au Gr. 2, le Gr. 3 avait un taux plus élevé de récidive locale : 1 cas (11,1 %) vs 4 cas (66,7 %) (p = 0,002), de déformation : 0 cas (0 %) vs 3 cas (50 %) (p = 0,023), et de fracture pathologique : 0 cas vs 1 cas (16,7 %) (p = 0,006). La biopsie osseuse est fondamentale dans la prise en charge des patients avec ODF et permet d’éliminer le diagnostic d’adamantinoma ou d’infection. L’observation est réservée aux patients asymptomatiques tandis que la chirurgie est indiquée chez les patients avec douleur, fracture pathologique ou déformation osseuse. Chez les patients symptomatiques avec une lésion de taille modérée, l’ESIN permet de préserver l’axe anatomique de l’os ; par contre, les lésions circonférentielles, ou les récidives, peuvent bénéficier d’une résection extrapériostée et d’un transfert osseux, même si le taux de complications est relativement élevé. III ; étude cas contrôle.

目的 探讨闭合复位克氏针空心钉内固定治疗青少年肱骨髁间T型骨折的方法 与疗效.方法 回顾性分析厦门大学附属福州第二医院收治的18例青少年肱骨髁间T型骨折患儿的临床资料,所有患儿采用闭合复位并克氏针空心钉内固定,术后采用高分子石膏托固定肘关节4～6周,当影像学检查提示骨折端骨痂形成满意后拆除高分子石膏托并拔除克氏针,开始进行肘关节功能锻炼.结果 9例Mayo肘关节功能评分达到优,7例评分良,优良率为88.9％.只有1例术后未按时复查及功能锻炼,出现了肘关节疼痛及轻度肘关节僵硬等后遗症,肘关节功能评分55分.术后影像学评估提携角平均18°(范围:10°～27°),未出现肘关节内外翻畸形.患侧与健侧的肘关节肌力无明显差异.术后1例出现克氏针钉道感染,经换药拔针后治愈.1例术前合并正中神经损伤者,术后观察3个月恢复正常.结论 闭合复位克氏针空心钉内固定治疗青少年肱骨髁T型骨折简单实用 、价格低廉且疗效满意,值得临床推广应用.

目的 目的比较经大转子外侧进带锁髓内钉和锁定钢板治疗青少年股骨干骨折的临床疗效.方法 回顾性分析2014年5月至2016年5月由三明市第二医院和福州市第二医院收治的29例青少年股骨干骨折患儿的临床资料.根据治疗方法的不同分为带锁髓内钉组(n=16)和钢板组(n=13).记录并比较两组患儿的切口长度、出血量、早期下地负重时间和临床愈合时间.末次随访时,测量并比较双侧的颈干角及冠状位股骨干轴线成角.采用NAHS评分法评估两组患儿患侧的髋关节功能.结果 髓内钉组的切口长度为(5.27±0.39)cm,钢板组(7.66±0.41)cm,差异有统计学意义(t=2.287,P=0.011);髓内钉组出血量和早期下地负重时间分别为(131.88±6.43)mL和(52.81±3.37)d,钢板组分别为(145.25±7.79)mL和(64.35±3.42)d,差异均有统计学意义(P<0.05).髓内钉组达到临床愈合的时间为(60.25±3.86)d,钢板组为(70.63±8.87)d,差异有统计学意义(t=2.594,P=0.028).髓内钉组患侧颈干角、冠状位股骨干轴线成角分别为(150.11±1.62)°和(178.88±0.49)°,健侧分别为(150.20±1.01)°和(178.84±0.34)°,差异均无统计学意义(P>0.05).钢板组患侧颈干角、冠状位股骨干轴线成角分别为(150.37±1.11)°和(178.88±1.09)°,健侧为(149.98±0.98)°和(179.12±0.42)°,差异均无统计学意义(P>0.05).髓内钉组和钢板组髋关节的NAHS评分分别为(94.19±2.37)分和(94.46±2.22)分,差异无统计学意义(t=0.317,P=0.748).末次随访时29例患儿均达到骨性愈合.钢板组有1例出现螺钉松动并延迟愈合,1例出现轻微股骨远端外翻畸形.结论相对于锁定钢板,带锁髓内钉治疗青少年股骨干骨折具有切口小,出血量少,愈合快,并发症少等优点.

目的 探讨3D打印三角骨块导板在Salter骨盆截骨术治疗儿童发育性髋关节脱位(DDH)中应用的可行性及效果.方法 回顾性分析自2016-09-2017-03诊治的13例儿童DDH,术前所有患儿均行骨盆CT断层扫描,并将数据导人Mimics软件,重建骨盆三维模型.参照正常髋臼前倾角和髋臼指数进行Salter骨盆截骨术前模拟,设计并3D打印维持截骨端稳定所需的三角骨块导板.术中用导板获取骨块,旋转截骨远端.结果 13例均获得随访,随访时间平均14.7(12～18)个月.末次随访时患儿双髋活动未见明显受限,未出现股骨头再脱位、股骨髋臼撞击征、股骨头坏死等并发症.末次随访时患侧髋关节功能Harris评分为(90.4±0.8)分,较术前明显提高,差异有统计学意义(P＜0.05).术后患侧髋臼前倾角、髋臼指数较术前明显改善,差异有统计学意义(P＜0.05),与正常值比较差异无统计学意义(P＞0.05).结论 3D打印三角骨块导板辅助Salter骨盆截骨术治疗儿童DDH可获得满意效果,术者可提前评估矫正后的髋臼前倾角、髋臼指数,便于制定手术方案,避免术中透视无法评估髋臼前倾角和术中主要依靠术者经验等局限性.

目的 探讨应用闭合复位弹性髓内钉内固定治疗儿童股骨干骨折的疗效.方法 从我院2011年6月—2018年12月接收的儿童股骨干骨折患儿中选取146例,将其随机分为观察组(73例)与对照组(73例).对照组给予普通牵引治疗,观察组给予闭合复位弹性髓内钉内固定治疗,对比2组患儿治疗效果及预后情况.结果 观察组治疗优良率明显高于对照组(P<0.05);观察组骨折愈合时间、完全负重时间、住院时间均低于对照组(P<0.05).结论 对儿童股骨干骨折患儿采用闭合复位弹性髓内钉内固定治疗效果确切,可有效缩短康复时间,值得可推广.