克氏针撬拨复位、弹性髓内针内固定治疗儿童Judet Ⅲ、Ⅳ型桡骨颈骨折
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摘要
目的探讨克氏针撬拨复位、弹性髓内针内固定治疗儿童JudetⅢ、Ⅳ型桡骨颈骨折的临床效果。方法采用克氏针撬拨复位、弹性髓内针内固定治疗28例JudetⅢ、Ⅳ型桡骨颈骨折患儿,术后行屈肘90°前臂中立位管型石膏外固定3周,去除外固定行功能锻炼。结果患儿均获得随访,时间6～24个月。均无切口感染。骨折均骨性愈合,未出现异位骨化,无骨骺早闭及骨桥形成。2例出现桡骨小头坏死,1例出现髓内针尾激惹。术后6个月,按照Tibone-Stoltz临床功能评定标准评价疗效:优23例,良3例,可2例;按照Metaizeau术后X线片评价标准评价复位情况:优22例,良5例,可1例。结论克氏针撬拨复位、弹性髓内针内固定治疗儿童JudetⅢ、Ⅳ型桡骨颈骨折,具有闭合复位成功率高,固定牢靠,创伤小、患肢功能恢复良好、并发症少等优点,是治疗儿童JudetⅢ、Ⅳ型桡骨颈骨折的理想选择之一。
Objective To investigate the clinical results of percutaneous Kirschner-wire pry-poking reduction and fixation with elastic stable intramedullary nails in the treatment of Judet type Ⅲ,Ⅳ radial neck fracture. Methods The28 children with radial neck fractures were treated by percutaneous Kirschner-wire pry-poking reduction and fixation with elastic stable intramedullary nails. Long arm tubular cast immobilization was applied for 3 weeks postoperatively and functional exercise was resumed after removal of the external fixation. Results All cases were followed up for6 ～ 24 months. There was no incisional infection. Bone healing was achieved in all fractures,no ectopic ossification,epiphyseal premature closure and osteopathogenesis occurred. Avascular necrosis of radial head was found in 2 cases,nail tail irritability was found in 1 case. At 6 months after surgery,according to Tibone-Stoltz evaluation standard evaluated the curative effect,23 cases were excellent,3 cases good and 2 fair. At 6 months after surgery,according to Metaizeau postoperative X-ray evaluation standard evaluated the reset condition,22 cases were excellent,5 cases good and 1 fair. Conclusions Percutaneous Kirschner-wire pry-poking reduction and fixation with elastic stable intramedullary nails for the treatment of radial neck fracture in children has advantages of high success rate of close reduction,reliable fixation,less trauma and complications,lead to excellent postoperative results. It is one of the ideal choices for the treatment of radial neck fractures in children.
Objective To investigate the clinical results of percutaneous Kirschner-wire pry-poking reduction and fixation with elastic stable intramedullary nails in the treatment of Judet type Ⅲ,Ⅳ radial neck fracture. Methods The28 children with radial neck fractures were treated by percutaneous Kirschner-wire pry-poking reduction and fixation with elastic stable intramedullary nails. Long arm tubular cast immobilization was applied for 3 weeks postoperatively and functional exercise was resumed after removal of the external fixation. Results All cases were followed up for6 ～ 24 months. There was no incisional infection. Bone healing was achieved in all fractures,no ectopic ossification,epiphyseal premature closure and osteopathogenesis occurred. Avascular necrosis of radial head was found in 2 cases,nail tail irritability was found in 1 case. At 6 months after surgery,according to Tibone-Stoltz evaluation standard evaluated the curative effect,23 cases were excellent,3 cases good and 2 fair. At 6 months after surgery,according to Metaizeau postoperative X-ray evaluation standard evaluated the reset condition,22 cases were excellent,5 cases good and 1 fair. Conclusions Percutaneous Kirschner-wire pry-poking reduction and fixation with elastic stable intramedullary nails for the treatment of radial neck fracture in children has advantages of high success rate of close reduction,reliable fixation,less trauma and complications,lead to excellent postoperative results. It is one of the ideal choices for the treatment of radial neck fractures in children.
引文
[1] Cossio A,Cazzaniga C,Gridavilla G,et al. Paediatric radial neck fractures:one-step percutaneons reduction and fixation[J]. Injury,2014,45(Suppl 6):80-84.
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[3]焦勤,罗义,陈柏松,等.弹性髓内针在儿童前臂骨折治疗中的应用[J].中华实用儿科临床杂志,2013,28(7):553-555.
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[5]郑继会,胡思斌,张永波,等.应用弹性髓内钉治疗儿童桡骨颈骨折[J].创伤外科杂志,2017,19(4):296-297.
[6] Tarallo L,Mugnai R,Fiaeehi F,et al. Management of displacedradical neck fracture in children:percultaneous pinning VSelastic stable in-tramedullary nailing[J]. J Orthop Traumatol,2013,14(4):291-297.
[7] Adams R C,Anderson M E,Birch J G,et al. Techdjian's pediatric orthopaedics[M]. 5th ed. Philadelphia:Saunders,2014:1314-1315.
[8]俞永智,刘杰,郭士方,等.弹性髓内针治疗儿童尺桡骨骨折[J].临床骨科杂志,2018,21(2):236-237.
[2] Falciglia F,Giordano M,Aulisa A G,et al. Radial neck fractures in children:results when open reduction is indicated[J]. J Pediatr Orthop,2014,34(8):756-762.
[3]焦勤,罗义,陈柏松,等.弹性髓内针在儿童前臂骨折治疗中的应用[J].中华实用儿科临床杂志,2013,28(7):553-555.
[4]鲍琨,陈博昌,冯林,等.儿童桡骨颈骨折的治疗[J].中华小儿外科杂志,2012,33(2):131-135.
[5]郑继会,胡思斌,张永波,等.应用弹性髓内钉治疗儿童桡骨颈骨折[J].创伤外科杂志,2017,19(4):296-297.
[6] Tarallo L,Mugnai R,Fiaeehi F,et al. Management of displacedradical neck fracture in children:percultaneous pinning VSelastic stable in-tramedullary nailing[J]. J Orthop Traumatol,2013,14(4):291-297.
[7] Adams R C,Anderson M E,Birch J G,et al. Techdjian's pediatric orthopaedics[M]. 5th ed. Philadelphia:Saunders,2014:1314-1315.
[8]俞永智,刘杰,郭士方,等.弹性髓内针治疗儿童尺桡骨骨折[J].临床骨科杂志,2018,21(2):236-237.