摘要
目的 探讨经皮克氏针撬拨复位弹性髓内钉固定治疗儿童重度桡骨颈骨折的疗效。方法 2010年11月-2014年8月,采用经皮克氏针撬拨复位后再植入弹性髓内钉固定方法治疗17例重度桡骨颈骨折患儿。男13例,女4例;年龄6~14岁,平均8.7岁。左侧8例,右侧9例。均为跌倒摔伤导致骨折。骨折成角64~102°,平均84°。按照Judet分型均为Ⅳ型,其中Ⅳa型7例,Ⅳb型10例。伤后至手术时间1~7 d,平均4.2 d。术后肘关节功能按照Tibone-Stoltz的临床功能评定标准评价;影像学评价按照Metaizeau等X线片评定标准评定。结果手术时间20~50 min,平均30 min。术后患者切口均Ⅰ期愈合,无感染、桡神经深支及感觉支损伤等并发症发生。17例均获随访,随访时间12~46个月,平均20个月。术后2个月时骨折均达骨性愈合,随访期间无骨折畸形愈合、骨骺早闭、桡骨头骺缺血性坏死、头骺变形膨大、肘内外翻、上尺桡关节融合等并发症发生。1例肘关节伸直轻度受限。末次随访时,肘关节屈伸及前臂旋转活动度与健侧比较,差异均无统计学意义（P〉0.05）。末次随访时,按Tibone-Stoltz的临床功能评定标准,获优16例,良1例,优良率100%。X线片测量骨折端成角0~12°,平均3.7°;17例均达到解剖复位或近似解剖复位,按Metaizeau等X线片评定标准,获优13例,良4例,复位优良率为100%。结论 经皮克氏针撬拨复位弹性髓内钉固定治疗儿童重度桡骨颈骨折简便、安全、微创、有效、并发症少,是一种理想的治疗方法。
Objective To assess the effectiveness of percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation for treating severe displaced radial neck fractures in children. Methods Between November 2010 and August 2014, 17 children with severe displaced radial neck fractures were treated with percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation. There were 13 boys and 4 girls with an average age of 8.7 years （range, 6-14 years）. The right side was involved in 9 cases, and the left side was involved in 8 cases. The causes of in）ury were falling in all cases. The angular deformity at fracture was 64-102° （mean, 84°）. According to the Judet classification, 7 cases were classified as grade IVa and 10 cases as grade IVb. The time from injury to operation was 4.2 days （range, 1-7 days）. Metaizeau classification and Tibone-Stoltz elbow performance score were used to access the radiological and clinical results, respectively. Results The operation time was 20-50 minutes （mean, 30 minutes）. All incisions healed by first intention. The patients were followed up 12-46 months （mean, 20 months）. All fractures healed at 2 months after operation. There was no complication of malunion, early epiphyseal closure, avascular necrosis, enlargement of the radial head epiphysis, cubitus varus and valgus deformities, or proximal radioulnar joint synostosis. One case had elbow extension limitation. At last follow-up, the elbow range of motion in flexion, extension, pronation, and supination showed no significant difference between affected side and normal side （P〉0.05）. The clinical results were excellent in 16 cases and good in 1 case, with an excellent and good rate of 100%. The angulation was 0-12° （mean, 3.7°） on the X-ray film; anatomic reduction or nearly anatomic reduction was obtained, and the radiological results were excellent in 13 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion Percutaneou
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第12期1478-1482,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
桡骨颈骨折
经皮
撬拨复位
内固定
儿童
Radial neck fracture
Percutaneous
Poking reduction
Internal fixation
Children
