摘要
目的为解决低龄儿童因桡骨头化骨核不显影导致复位困难的问题,采用术中肘关节造影方法辅助术中复位,观察复位效果。方法自2016年1月至2018年1月对16例桡骨头化骨核显影不明显或不显影的桡骨颈骨折儿童行术中肘关节造影,然后经皮克氏针撬拨复位内固定治疗。其中男性7例,女性9例;年龄2～7岁,平均5岁1个月。按O’brien分型,Ⅱ型9例,Ⅲ型7例。术中肘关节造影采用肘关节外侧入路,造影剂为碘海醇。采用1枚2.0mm克氏针进行经皮插入骨折断端撬拨复位,2枚1.2～1.5mm克氏针通过骨折断端或骨折断端近端内固定。根据术后并发症发生情况及临床疗效评价术中造影对复位效果的影响。结果术中肘关节造影可以清楚地显示桡骨头的关节面,有效辅助经皮撬拨复位,直观地判断复位后的效果。按照Metaizeau的整复标准评价,优14例,良2例,优良率100%。术后随访时间9～30个月,平均21个月。按照Metaizeau的疗效标准评价,16例均为优,优良率100%。随访时拍片复查未见尺桡骨近端骨性连接,无桡骨头缺血坏死,无针眼感染及桡神经深支损伤发生。术后并发症发生率为零。结论术中肘关节造影辅助经皮克氏针撬拨闭合复位,可有效提高儿童桡骨颈骨折桡骨头化骨核不显影的复位优良率及临床疗效优良率。
Objective To observe the effect of intraoperative elbow arthrography in reduction of radial neck fractures of the young children and solve the problem caused by the nonvisulization of radial head ossified nucleus. Methods Intraoperative elbow arthrographies were performed in 16 cases of radial neck fractures whose radial head nuclei were not clear in X ray image and then the reductions were performed by leverage of percutaneous Kirschner wire.There were 7 males and 9 females.The average age was 5 years and 1 month old. According to O’brien classification,there were 9 cases of type Ⅱ and 7 cases of type Ⅲ.The approach of lateral of the elbow joint was chosen to perform the arthrography.Iohexol was the contrast agent.After satisfactory reduction,two Kirschner needles were fixed through the fracture site or the proximal fracture site.The occurrence of postoperative complications and the clinical effects were observed. Results Intraoperative elbow arthrography could clearly show the articular surface of the radial head,assistpercutaneous leveragereduction.According to the reduction criterion of Metaizeau,14 cases were excellent,2 cases were good,and the excellent and good rate was 100%.From follow up of average 21months(range 9 months to 30 months),16 cases were excellent according to the effect criterion of Metaizeau,and the excellent and good rate was 100%.There was no proximal osseous junction and no ischemic necrosis of the radial head.No needle infection or injury to the deep branch of the radial nerve occurred.There was no postoperative complications. Conclusion Closed reduction assisted by intraoperative elbow arthrography through percutaneous reduction by leverage and internal fixation can effectively improve the excellent and good rate of reduction of radial neck fracture in children without visulization of radial head ossified nucleus in young children.
作者
姜海
吴永涛
汪兵
李晓博
薛英森
邱裕生
Jiang Hai;Wu Yongtao;Wang Bing(Department of Orthopedics Surgery,Northwest Women’s and Children’s Hosital,Xi’an 710061,China;Department of Pediatric Orthopedics Surgery,Honghui Hospital,Xi’an Jiaotong University,Xi’an 710054,China)
出处
《实用骨科杂志》
2019年第3期197-200,204,共5页
Journal of Practical Orthopaedics
关键词
肘关节
造影
儿童
桡骨颈骨折
elbow joint
arthrography
children
radial neck fracture
