【摘要】 目的探讨儿童和青少年胫骨骨折后急性骨筋膜室综合征(ACS)的发生率及危险因素。方法回顾性研究2014年1月—2018年12月淮安市第一人民医院分院骨科收治的350例儿童和青少年胫骨骨折患者,男性282例,女性68例;年龄5～18岁,平均10.4岁。根据患者胫骨骨折后是否发生ACS,分为ACS发生组(15例)和ACS未发生组(335例)。比较两组患者在性别、年龄、体质量指数(BMI)、致伤机制、初诊科室、骨折位置、骨折类型、开放性骨折、同侧胫骨远端骨折、并发症发生、胫骨骨折后损伤、粉碎性骨折、合并腓骨骨折、距踝关节距离、手术治疗、合并其他部位损伤、合并休克等方面的差异。采用Logistic回归分析影响儿童和青少年胫骨骨折后ACS发生的危险因素。结果 350例患者中发生ACS 15例,发生率4.29%。两组患者在年龄、BMI、胫骨骨折后损伤、骨折类型、粉碎性骨折、合并腓骨骨折、距踝关节距离、手术治疗方面差异有统计学意义(t=-3.101,P=0.002; t=-2.142,P=0.033;χ2=5.414,P=0.020; F=4.225,P=0.007;χ2=4.512,P=0.035;χ2=8.927,P=0.003; t=-4.104,P<0.001;χ2=26.471,P<0.001)。多因素Logistic回归分析结果显示,年龄偏小、距踝关节距离偏近是儿童和青少年胫骨骨折后ACS发生的独立保护因素,骨折类型(粉碎)、合并腓骨骨折为独立危险因素。结论年龄偏大、骨折类型(粉碎)、合并腓骨骨折、距踝关节距离偏远的儿童和青少年胫骨骨折患者ACS发生风险较大。更多还原

【Abstract】 Objective To investigate the incidence and risk factors of acute compartment syndrome( ACS) after tibial fracture in children and adolescents. Methods From Jan. 2014 to Dec. 2018,a retrospective study was conducted on 350 children and adolescents with tibial fractures who were treated in the First People’s Hospital of Huai’an City. There were 282 males and 68 females,aged 5-18( 10. 4 on average) years. According to the occurrence of ACS after tibial fracture,the patients were divided into ACS occurrence group( n = 15) and ACS non-occurrence group( n = 335). The differences in gender,age,body mass index( BMI),injury mechanism,initial diagnosis department,fracture location,fracture type,open fracture,ipsilateral distal tibial fracture,complications,injury after tibial fracture,fracture type( comminuted type),combined fibula fracture,distance from ankle joint,surgical treatment,combined with other parts of the injury and combined with shock were compared between the two groups. Logistic regression analysis was used to analyze the risk factors of ACS after tibial fracture in children. Results Among the 350 cases of tibial fracture in children and adolescents,15 cases( 4. 3%) had ACS. There were significant differences between the two groups in age,BMI,injury after tibial fracture,fracture type,comminuted fracture,fibular fracture,distance from ankle joint,surgical treatment( t =-3. 101,P = 0. 002; t =-2. 142,P = 0. 033; χ2=5. 414,P = 0. 020; F = 4. 225,P = 0. 007; χ2= 4. 512,P = 0. 035; χ2= 8. 927,P = 0. 003; t =-4. 104,P< 0. 001; χ2=26. 471,P<0. 001). Multivariate logistic regression analysis showed that younger age and closer distance from ankle were independent protective factors for ACS after tibial fracture in children and adolescents,and fracture type( comminuted type) and fibular fracture were independent risk factors. Concluson The risk of ACS is higher in children and adolescents with older age,fracture type( comminuted type),combined fibular fracture and long distance from ankle joint.更多还原