目的 探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)支具治疗后肩平衡相关参数变化及影响因素.方法 选择2012年6月至2021年12月我院支具治疗的82例AIS患者,分别于治疗前及治疗后末次随访时拍摄自然站立位全脊柱正侧位X线片,根据治疗后影像学肩关节高度差(radiographic shoulder height,RSH)分级绝对值是否大于治疗前将患者分为双肩平衡组和双肩失衡组.对比两组患者肩平衡参数,分析RSH与其他影像学参数的相关关系,多因素分析探讨AIS患者支具治疗后双肩失衡的影响因素.结果 治疗后肩失衡发生率为23.17％,支具治疗前,双肩失衡组锁骨角(clavicular angle,CA)、锁骨轮廓角度差(clavicular contour angle difference,CCAD)均高于双肩平衡组(P＜0.05).与治疗前比较,两组患者治疗6个月及2年后RSH、上胸弯Cobb角、主胸弯Cobb角、CA及T1倾斜角均显著改善,双肩平衡组改善效果更佳(P＜0.05).双肩失衡患者治疗后RSH与治疗前CA及CCAD呈显著正相关(r=0.896、0.882,P＜0.05),与上胸弯柔韧度呈显著负相关(r=-702,P＜0.05);治疗后RSH变化与CA变化、上胸弯角度变化、上胸弯矫正率、主胸弯角度变化、主胸弯矫正率呈显著正相关(r=0.906、0.644、0.708、0.815、0.878,P＜0.05).Risser征＞3、初发Cobb角≥35°及椎体旋转度≥Ⅲ度是患者支具治疗后双肩失衡的独立危险因素(P＜0.05).结论 AIS患者经支具治疗后RSH、上胸弯Cobb角、主胸弯Cobb角、CA及T1倾斜角均显著改善,Risser征、初发Cobb角及椎体旋转度是AIS患者支具治疗后双肩失衡的独立危险因素.

Objective:To analyze the characteristics of aneurysmal bone cysts (ABC) and related factors of postoperative recurrence, so as to improve the clinical diagnosis and treatment level of ABC in children.Methods:The clinical data of children pathologically diagnosed as ABC after surgery in the Affiliated Hospital of Zunyi Medical University from January 2010 to December 2018 were retrospectively analyzed.Clinical characteristics of the patients, including age, gender, lesion sites, and main clinical manifestations (pain, swelling, local tenderness, joint dysfunction and pathological fracture) were analyzed and summarized.Before operation, imaging Enneking staging was carried out, cyst volume was estimated, and the distance from cysts to the epiphyseal plate was measured.During surgery, patients received lesion curettage, local cautery and bone grafting, and the pathological fractures were treated with auxiliary internal fixation.Results were determined by Neer imaging grading after surgery, and grades Ⅰ and Ⅱ were postoperative recurrence.Possible recurrence factors were analyzed statistically by Fisher′ s exact test. Results:A total of 29 cases meeting the criteria were included, including 19 males and 10 females.The age ranged from 3.6 to 14.0 years old, averaging 9.2 years old; 12 patients were smaller than 10 years old and 17 patients were older than 10 years old.The cysts of 9 cases were located in proximal femur (31.0%), 5 cases in proximal humerus (17.2%), and 4 cases in proximal fibula (13.8%); The other 11 cases (37.9%) occurred in the middle and distal end; 26 cases (89.7%) had local tenderness, 25 cases (86.2%) showed varying degrees of pain, 18 cases (62.1%) presented local swelling, 15 cases (51.7%) were accompanied by joint dysfunction, and 12 cases (41.4%) were combined with pathological fractures.According to Enneking staging results, 18 cases (62.1%) were at rest stage, 7 cases (24.1%) at active stage, and 4 cases (13.8%) at invasive stage.Cyst volume was estimated to be 3.3-172.0 cm 3, with a median of about 50.8 cm 3.The distance from cysts to the epiphyseal plate was 0-85.0 mm, with a median of 20.8 mm.All children were followed up for 2.2-10.1 years (averaging 3.8 years). There were 6 cases (20.7%) of grades Ⅰ and Ⅱ according to Neer grading standard, and they suffered from recurrence about 2.5-20.3 months after surgery (averaging 12.5 months). The recurrence rate was higher in patients with cyst volume >50.8 cm 3 (42.9%, 6/14 cases) as well as in patients at active stage and invasive stage (45.5%, 5/11 cases) ( P<0.05). There was no statistical difference between the recurrence rate of ABC in different gender, age, the distance from cysts to the epiphyseal plate and pathological fractures. Conclusions:ABC is prone to occur in the proximal metaphysis of the long bones of children′s extremities.Main manifestations are pain, swelling, local tenderness and joint dysfunction, and ABC is frequently accompanied by pathological fractures.A higher postoperative recurrence rate is related to a larger cyst size and the active and invasion phases of the cyst, but gender, age, the distance from the cyst to the epiphyseal plate and pathological fractures are not significantly related to the postoperative recurrence rate.

Objective:To analyze the clinical characteristic of patellar sleeve fracture in children, so as to improve the understanding of pediatric patellar sleeve fracture and reduce the misdiagnosis rate.Methods:Clinical data of 18 children with patellar sleeve fractures admitted and followed up in Department of Pediatric Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University from January 2013 to December 2019 were retrospectively analyzed, including 10 males and 8 females with the mean age of 11.4 years (8.0-14.0 years). There were 10 right patellar sleeve fracture cases, 7 left cases, and 1 case on both sides.Classified by the fracture cause, 10 cases were caused by falls, 3 cases of high jump, 2 cases of falling from height, 2 cases of car accidents, and 1 case of rope skipping, and all of cases were closed injuries.The mean post-injury visit to Affiliated Hospital of Zunyi Medical University was 3.5 days (4 hours -7 days). Twelve out of cases were transferred from other hospitals.All patients were treated with the open reduction and tension band wiring or patella tendon suturing through bone tunnel + patella circumferential wire banding and fixation.The curative effect of patella fracture was evaluated by the Bostman score.Results:Eighteen children with patellar sleeve fracture were diagnosed and treated promptly after admission, and regularly followed up after the operation for an average of 14 months (9-28 months). All cases achieved stage Ⅰ wound healing, and Kirschner wires and steel wires were removed according to the condition of fracture healing at 6 to 10 months postoperatively.According to the Bostman score for evaluating the patella fracture, 15 cases were excellent, 3 cases were good, and there were no missed or misdiagnosed cases.Conclusions:Patella sleeve avulsion fracture is a unique type of fracture in children.As cartilage is the main distal avulsion fracture lesion, it is difficult to be detected on X-ray scans, thus easily leading to missed diagnosis and misdiagnosis.Improving the understanding of this fracture type is the key to the early diagnosis and treatment.

[目的]比较不同年龄段行后路半椎体切除术治疗单纯半椎体脊柱畸形的临床效果.[方法]回顾性分析2013年1月—2020年12月收治的80例单纯半椎体脊柱畸形低龄患儿临床资料,按年龄段不同分为幼龄组43例,大龄组37例,均行后路半椎体切除术治疗.比较两组围手术期、随访及影像资料.[结果]两组患儿均顺利完成手术,术中无神经、血管损伤等并发症.幼龄组手术时间、术中出血量、固定节段均显著少于大龄组(P＜0.05).两组患者均获随访,随访时间10～12个月,平均(11.05±0.84)个月.随时间推移,两组坐高、身高均较术前显著增加(P＜0.05),两组下地活动时间、完全负重时间、坐高变化率和并发症发生率的差异均无统计学意义(P＞0.05).影像方面,与术前相比较,术后即刻和末次随访时两组后凸Cobb角、侧凸Cobb角和C7PL-CSVL均显著减小(P＜0.05).相应时间点,幼龄组的后凸Cobb角、侧凸Cobb和C7PL-CSVL显著小于大龄组(P＜0.05).两组术后即刻、末次随访的后凸、侧凸Cobb角矫正率与C7PL-CSVL矫正率的差异均无统计学意义(P＞0.05).经Pearson相关分析发现:年龄与手术时间、失血量呈正相关(P＜0.001),与坐高变化率、后凸Cobb角、侧凸Cobb角和C7PL的矫正率无相关性(P＞0.05).[结论]早期对单纯半椎体脊柱畸形低龄患儿行后路半椎体切除术可缩短手术时间,减少术中出血量与固定节段.

目的:比较瘤体内注射与外用博来霉素治疗浅表型婴幼儿血管瘤的疗效.方法:选取2018年12月至2019年12月我院小儿矫形外科住院浅表型血管瘤患儿,随机分成两组,分别予以博来霉素瘤体内注射治疗与瘤体表面外涂治疗.结果:共收集40例浅表型婴幼儿血管瘤,注射组与外用组各20例.外用组显效12例,有效8例,注射组显效14例,有效6例,两组疗效差异无统计学意义(P>0.05).注射组治疗后瘤体质地硬,而外用组治疗后瘤体质地软;注射组主要不良反应为瘤体局部坏死或感染(P<0.05),外用组未见明显不良反应.结论:外用博来霉素治疗浅表型婴幼儿血管瘤疗效确切,治疗后不良反应少.

目的 总结儿童髋关节一过性滑膜炎(TSH)的临床特点,进一步提高对该病的诊治水平.方法 回顾性分析2010年1月至2019年12月于遵义医科大学附属医院小儿矫形外科治疗的1054例入院诊断为髋关节性滑膜炎患儿的临床资料并分析其特点.结果 1054例中最终确诊967例,其中男性702例,女性265例,男女发病数量比较差异具有统计学意义(P<0.05);患儿年龄0.5～14岁,平均年龄(5.6±3.1)岁;170例有呼吸道感染病史,39例有外伤史,18例有剧烈活动病史,1例有腮腺炎病史;秋季多见,4月、9月为发病高峰;实验室检查多数患儿表现为淋巴细胞及单核细胞计数的增加,超声及MRI检查多提示髋关节积液、滑膜增厚及软组织肿胀;单髋发病917例,双髋发病50例.患儿主要表现为髋关节疼痛伴跛行(555例),部分可仅表现为跛行(150例)或伴大腿或膝关节的疼痛(108例),少数可仅表现为髋关节疼痛(73例)或伴下肢拒绝承重(67例),极少数仅表现为大腿或膝关节疼痛(14例),所有患者均出现不同程度的髋关节活动受限.结论 儿童TSH好发学龄前期,男性多见,单侧发病较多,主要表现为不同程度的髋关节疼痛、活动受限、患肢乏力及跛行,治疗上主要以卧床休息及患肢牵引制动为主.

目的 分析外涂博来霉素软膏治疗浅表型婴幼儿血管瘤的临床疗效.方法 选取我院于2019年6月—2020年6月诊治的浅表型婴幼儿血管瘤患儿78例为研究对象,征求家属意愿后分为治疗组(外涂博来霉素软膏)66例及观察组12例(定期观察患儿瘤体大小、颜色及质地变化情况),统计患儿年龄、性别、瘤体部位、大小、颜色及质地情况,治疗3个月后根据瘤体变化按三级疗效评定法评价疗效,并记录患儿的不良反应.结果 两组患儿年龄、性别比较差异无统计学意义(P>0.05);疗效评定:治疗组:Ⅲ级41例,其中完全消退5例,Ⅱ级20例,Ⅰ级5例,观察组:Ⅲ级1例,Ⅱ级2例,Ⅰ级9例,两组有效率比较,治疗组(92.42％)明显高于观察组(25.00％),差异具有统计学意义(P<0.05),两组消退率比较,治疗组(62.12％)明显高于观察组(8.33％),差异具有统计学意义(P<0.05),78例患儿在治疗及观察中均未发现明显不良反应.结论 外涂博来霉素治疗浅表型婴幼儿血管瘤疗效确切,无明显不良反应,家属更易接受,可作为治疗浅表型婴幼儿血管瘤的方法之一.

目的 探讨先天性绞扼轮综合征的手术治疗方法 .方法2013年7月—2018年11月手术治疗先天性绞扼轮综合征患儿9例,均采用一期手术切除束带,Z形松解成形的方法进行治疗,其中2例小腿束带合并马蹄内翻足患儿先予束带切除、成形手术,术后1年行在Ponseti石膏疗法基础上行马蹄内翻足软组织广泛松解、肌腱转移手术.结果 9例全部手术切口愈合良好,未出现皮瓣坏死,环状缩窄带得到充分松解.2例小腿束带合并马蹄内翻足术后畸形矫正满意,未出现复发.结论 1期手术切除束带并松解成形,不会导致皮瓣的坏死,而且可获得较满意的外观,Ponseti石膏疗法基础上行马蹄内翻足软组织广泛松解、肌腱转移手术是治疗束带合并马蹄内翻足优良的手术方法.

目的:观察支具矫正联合姿态训练治疗青少年特发性脊柱侧弯的临床疗效.方法:选取2015年6月-2019年1月我院诊治的60例青少年特发性脊柱侧弯患儿,均予支具矫正联合姿态训练进行治疗.比较治疗前后患儿脊柱Cobb角的变化情况.结果:60例患儿,经随访6-18个月,失访3例.57例患儿经治疗后,胸、腰椎Cobb角较治疗前缩小,差异有统计学意义(P<0.05).结论:支具矫正联合姿态训练对Cobb角为25°-45°的青少年特发性脊柱侧弯患者具有较好的疗效.

目的 探讨白细胞介素-1β(IL-1β)和胰岛素样生长因子-1(IGF-1)在发育性髋脱位(DDH)髋臼软骨细胞增殖和凋亡中的作用及意义.方法 选取4周龄实验幼兔32只,采用左侧后肢伸膝屈髋位管型石膏固定方法制作DDH动物模型,右侧后肢不做特殊处理作为对照侧,将幼兔平均分为4组(A、B、C、D组),分别在石膏固定8、12、16、20周后处死,采用免疫组织化学法和Western blot法检测双侧髋臼外缘软骨块及细胞中IL-1β和IGF-1的表达情况和蛋白水平,结果进行统计学分析.结果 IL-1β和IGF-1在双侧髋臼软骨细胞中均有不同程度的阳性表达;D组实验侧髋臼软骨中IL-1β的阳性率和蛋白水平最高,B、C、D组实验侧和对照侧比较,差异有统计学意义(P＜0.05).C组实验侧髋臼软骨中IGF-1的阳性率最高,B组实验侧髋臼软骨中IGF-1的蛋白水平最高,B、C组实验侧和对照侧比较,差异有统计学意义(P＜0.05).结论 IL-1β与IGF-1在DDH髋臼软骨细胞中的表达异常,导致软骨细胞增殖和凋亡之间失衡,可能是DDH发生髋关节退行性变的原因之一.

目的 研究基质金属蛋白酶-7(MMP-7)在增生期、消退期婴幼儿血管瘤及正常皮肤组织中表达情况,并探讨其临床意义.方法 采用即用型快捷免疫组化MaxVisiorn/HRP检测法检测MMP-7、Ki67在增生期血管瘤(20例)、消退期血管瘤(20例)及正常皮肤(20例)表达情况;夹心法酶联免疫吸附法(ELISA)检测增生期血管瘤患者血清(36例)与正常对照组(36例)血清中MMP-7的表达情况.结果 MMP-7在增生期婴幼儿血管瘤中高表达,在消退期弱阳性表达,在正常皮肤中不表达.增生期与消退期、增生期与对照组比较差异均有统计学意义(P＜0.05);Ki67在增生期高表达,消退期低表达,在正常组织中不表达或弱表达,增生期与消退期、增生期与正常组织比较差异有统计学意义(P＜0.05);MMP-7在血管瘤患儿血清中的表达水平较正常对照组高,两者比较差异有统计学意义(P＜0.05).结论 MMP-7在血管瘤中有阳性表达,其不同表达水平可能和血管瘤发生发展消退有关.

目的 分析血清胰岛素样生长因子-1 (insulin-like growth factor-l,IGF-Ⅰ)在Perthes病患儿体内的表达及意义.方法 选取2015年1月～2018年12月来本院诊治的34例Perthes病惠儿为研究对象,均获得确诊,将其视作观察组,再选取同时期住院年龄、性别等情况相似的34例正常血清儿童为研究对象,将其视作对照组,两组患儿均采用酶联放射免疫法测定IGF-Ⅰ表达情况,并对其差异进行对比分析.结果 观察组患儿体内IGF-Ⅰ测定值为(62.74±24.34) ng/mL,低于对照组的(86.57±42.77) ng/mL,差异有统计学意义(P＜0.05).结论 IGF-Ⅰ在Perthes病患儿体内明显降低,故在Perthes病诊断中具有一定临床意义.

目的:研究弹性髓内钉与钢板治疗儿童尺桡骨双骨折的疗效.方法:选取2011年1月-2014年12月和2015年1月-2018年12月我院收治的57例儿童尺桡双骨折患者作为研究对象,按照时间分两组观察组和对照组,观察组29例,对照组28例,对照组采用钢板治疗,观察组采用弹性髓内钉治疗,对比两组的住院治疗时间、石膏固定时间、并发症发生率以及治疗有效率.结果:观察组与对照组比较,观察组的住院治疗时间短、石膏固定时间短,并发症发生率低,伤口感染发生率低,治疗有效率高,各项对比差异有统计学意义,P＜0.05.结论:弹性髓内钉治疗儿童尺桡骨双骨折有较好的治疗效果,可以缩短住院治疗时间,降低并发症和伤口感染的发生率,治疗有效率也更有保障,在临床儿童尺桡骨双骨折治疗中实用价值显著,值得广泛的推荐运用.

Objective To explore the effect of oral propranolol on growth and development of children with infantile hemangiomas (IHs).Methods Among 151 IHs children,145 finished all treatments and received outpatient follow-ups from July 2013 to June 2015.Their initial treatment age was around 3 months.Weight and height were recorded for evaluating their growth and development status before the age of 4 years.And the corresponding data of normal children of the same age were collected for comparison.Results At the age of 48 months,the mean values of height and weight were (105.07±3.36) cm and (15.56±1.31) kg in treatment group and (105.14±4.92) cm and (15.88±1.79) kg in control group.No significant inter-group difference existed in height or weight (P＞ 0.05).Conclusions Long-term oral propranolol has no impairment of growth and development of IHs children.

目的 分析儿童尺桡骨骨折保守治疗的效果.方法 选取2017年01月～12月我院收治的儿童闭合性尺桡骨骨折患儿113例作为研究对象,经过1年的随访,观察临床治疗效果.结果?113例患者入院后都予以行骨折手法复位、石膏固定.93例当时复位满意,予以石膏固定,其中2例2周内复查时出现明显移位改行手术内固定治疗.20例复位失败,予以手术治疗.所有患者骨折愈合都比较好.结论 对尺桡骨骨折儿童进行保守治疗,患儿骨折复位效果显著,有临床推广价值.

Objective To compare and study the effect of two practice models on clinical practice teaching in pediatric orthopedic surgery.Methods A total of 60 5-year undergraduate interns were selected and assigned randomly separately into control group (n=30) and experimental group (disease-based internship group,n=30).The control group took bed-based internship model,that is,interns managed patients with fixed beds.The experimental group took disease-based internship model,that is,interns managed the same disease patients and rotated regularly.Both groups used the same teaching method,namely the PBL+ LBL teaching.At the end of the internship,SPSS 18.0 was used to analyze the data,the independent sample t test and Chi-square test were used to compare the results of the two groups.Results In the dimensions of theoretical knowledge,medical records written and consolidated results,the score of the experimental group were higher than the control group,and the differences were statistically significant (P＜0.05).The score of practical skill in two groups had no statistically significant difference (P＞0.05).The satisfaction survey showed that the experimental group had higher satisfaction than the control group,and the difference was statistically significant (P＜0.05).Conclusion The disease-based internship model is better than the bedbased internship model in clinical practice teaching in pediatric orthopedic surgery,and can improve the quality of clinical teaching practice.

Objective To investigate the drug resistance and its changes of Staphylococcus aureus (SA) in children with bone and joint infection caused by hematogenous dissemination in Zunyi area.Methods A retrospective study was performed on the clinical data of 95 cases with bone and joint infections caused by SA from January 2008 to December 2016 in the Affiliated Hospital of Zunyi Medical College,in which there were 53 boys and 42 girls with a mean age of 5.6 years (ranging from 10 days to 14 years),including 39 cases of acute osteomyelitis,31 cases of acute suppurative arthritis,19 cases of chronic osteomyelitis,and 6 cases of acute osteomyelitis and arthritis.According to the results of drug sensitivity,the drug resistance of SA was analyzed,and the detection rates of Methicillin resistant Staphylococcus aureus (MRSA) were compared in different genders and timeframes,and the drug resistance of SA to other antibiotics were also analyzed.Results The detection rate of MRSA was 50.53％ (48 cases) in 95 cases,the resistance rate to Penicillin was 92.63％ (88 cases),and to Lincomycin,Erythromycin,Tetracycline and Cefoxitin were 64.21％ (61 cases),57.90％ (55 cases),55.79％ (53 cases) and 53.68％ (51 cases) respectively,but to Sulfamethoxazole Co.,Gentamicin and Rifampicin it was relatively low[25.26％ (24 cases),11.58％ (11 cases),6.32％ (6 cases) respectively],while the resistance to Moxifloxacin,Linezolid,Tigecycline,Vancomycin and Nitrofurantoin was not found.The detection rate of MRSA in boys (52.83 ％,28/53 cases) was slightly higher than that of girls (47.62％,20/42 cases),but the difference was not statistically significant (x2 =0.255,P ＞0.05).The detection rates of MRSA in 2008-2010,2011-2013 and 2014-2016 were 27.78％ (5/18 cases),51.61％ (16/31 cases) and 58.70％ (27/46 cases) respectively,and it was obviously higher in 2014-2016 than in 2008-2010,and the difference was statistically significant (x2 =4.95,P ＜ 0.05).The drug resistance rate of SA to Lincomycin,Erythromycin and Cefoxitinis was obviously higher in 2014-2016 than in 2008-2010,and the differences were all statistically significant (all P ＜ 0.05).Conclusions The drug resistance of SA is high with the bone and joint infection caused by hematogenous dissemination in children,and the detection rate of MRSA and the drug resistance of SA to a variety of antimicrobial agents are gradually increasing.

目的 探讨儿童软组织感染(STI)病原菌及其耐药性.方法 分析某院2010年1月--2017年1月收治的细菌培养阳性的STI患儿,并分为社区STI组和医院感染STI组,对STI病原菌及其耐药性进行分析.结果 共收治165例细菌培养阳性的STI患儿.社区STI组98例,医院感染STI组67例.共培养出细菌16种.98例社区STI均为单细菌感染,其中革兰阳性(G+)菌92株,主要为金黄色葡萄球菌(85株,86.7％o)、化脓性链球菌(4株,4.08％);革兰阴性(G-)菌6株,主要为大肠埃希菌(3株,3.06％)、肺炎克雷伯菌(2株,2.04％).医院感染STI组67例,5例为两种细菌混合感染,共培养出细菌72株,G+菌13株,主要为金黄色葡萄球菌(9株,12.50％);G菌59株,主要为大肠埃希菌(21株,29.17％)、铜绿假单胞菌(1 5株,20.83％)、阴沟肠杆菌(13株,18.06％).金黄色葡萄球菌对青霉素、红霉素、林可霉素耐药率＞50％,对庆大霉素、复方磺胺甲噁唑和利福平的耐药率＜20％,耐甲氧西林金黄色葡萄球菌的检出率为43.62％,未发现对万古霉素、利奈唑胺、替加环素、左氧氟沙星、莫西沙星和呋喃妥因耐药菌株.大肠埃希菌对头孢呋辛、复方磺胺甲噁唑的耐药率＞70％o,对哌拉西林、头孢吡肟和左氧氟沙星的耐药率＜30％,未见对亚胺培南耐药的大肠埃希菌及铜绿假单胞菌菌株.结论 儿童社区STI病原菌以金黄色葡萄球菌为主;医院感染STI病原菌以大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌等G-菌为主.儿童STI在未明确病原菌之前,可根据感染的类型选择相应的抗菌药物.

[目的]探讨手法闭合复位经皮穿针治疗儿童胫腓骨远端骨骺、干骺端骨折的方法与临床效果.[方法]选取2015年1月～2017年8月本院收治的儿童胫腓骨远端骨骺、干骺端骨折患儿30例,其中男22例,女8例,左侧19例,右侧11例,年龄7～ 14岁,平均(10.32±2.83)岁.胫腓骨远端骨骺骨折根据Salter-Harris标准分型,胫骨骨骺骨折Ⅰ型3例、Ⅱ型24例、Ⅳ型1例;胫骨远端干骺端骨折2例;腓骨远端骨骺骨折Ⅰ型1例、Ⅱ型2例;腓骨远端干骺端骨折27例.C型臂下手法闭合复位,经皮于胫骨骨折远端钉人2枚交叉克氏针固定;腓骨下段骨折,移位明显者复位后经外踝尖穿入克氏针髓内固定.[结果]本组30例均获6～30个月随访,平均(14.36±8.72)个月.观察统计手术时间,出血量,术后肿胀、疼痛情况,骨折愈合时间,根据Johner-Wruhs评分评定疗效:优29例,良1例,优良率100％.[结论]闭合复位经皮穿针治疗儿童胫腓骨远端骨骺及干骺端骨折创伤小、出血少、并发症少、美观、骨折愈合率高及关节功能恢复良好;对于胫骨远端骨骺Ⅲ型、Ⅳ型骨折,骨折块关节内移位明显经手法不能复位者应采取切开复位,避免反复闭合手法复位造成骺板的进一步损伤.

目的 探讨组织工程技术修复幼兔骺板软骨损伤的可行性,为儿童骺板损伤的治疗提供实验基础.方法 选取2周龄幼兔制作动物模型,采用钻孔法造成股骨远端骺板缺损,提取幼兔自体髂骨MSCs,种植到含有TGF-β、IGF-1、bFGF的明胶海绵支架上,并移植到手术造成的幼兔股骨远端外侧骺板缺损区,右侧作为实验组;左侧造成缺损后仅植入明胶海绵支架,作为自身对照组.术后每隔4周(4、8、12、16周)处死5只幼兔,观察不同时间点股骨及膝关节大体形态学及组织形态学变化,免疫组化法检测骺板损伤区骨桥组织形成情况,结果 进行统计学分析.结果从术后第4周开始,两组均出现不同程度的膝关节外翻畸形,但对照组的膝外翻畸形较重,合并有不同程度的股骨短缩畸形,两组畸形在16周时差异最明显.组织学显示实验组骺板缺损区骨桥组织形成较少,被排列和结构紊乱的软骨组织填充,对照组骺板损伤区骨桥组织较明显,部分骺板早闭.免疫组化结果显示实验组骺板损伤区FGFR-3和PCNA的表达呈阳性,两组比较;差异有统计学意义(P<0.05).结论 采用组织工程技术,以明胶海绵为支架,细胞因子诱导幼兔MSCs成软骨细胞修复幼兔骺板软骨缺损,可减少肢体畸形发生,方法简单,为儿童骺板损伤的治疗提供了一种新的选择.