微创双弹性髓内钉治疗儿童不稳定性桡骨下段骨折的疗效观察
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摘要
目的:探讨微创双弹性髓内钉对儿童不稳定性桡骨下段骨折的临床治疗效果。方法:选择诊断为不稳定性桡骨下段骨折患儿124例,采用随机数字法将所有患儿平均分为观察组62例和对照组62例,观察组患儿采用微创双弹性髓内钉法治疗,对照组患儿采用常规切开复位钢板内固定法治疗,对比观察两组患儿的手术时间、术中失血量、手术费用以及骨折愈合时间等指标,对所有患儿进行12个月的随访,对比两组患儿骨折不愈合、骨桥形成、骨髓炎、桡神经损伤以及再骨折等并发症发生情况,并根据患儿复查时X线检查结果,采用Flynn髓内钉疗效评估标准对患儿骨折愈合情况进行评价,同时采用Gartland和Werley腕关节评分对患儿的腕功能进行评价。结果:观察组患儿的手术时间和术中出血量均明显低于对照组患儿,但手术费用显著高于对照组患儿,差异均具有统计学意义(P<0.05)。两组患儿的骨折愈合时间比较差异无统计学意义(P>0.05)。观察组患儿术后并发症总发生率为4.8%,对照组患儿术后并发症总发生率为6.5%,两组患儿并发症发生率比较差异无统计学意义(P>0.05)。两组患儿的术后愈合情况以及恢复后的腕功能评价比较,差异均无统计学意义(P>0.05)。但观察组患儿的治疗优秀率显著高于对照组患儿,差异具有统计学意义(P<0.05)。结论:微创双弹性髓内钉对不稳定性桡骨下段骨折患儿的治疗效果理想,虽然使用双弹性髓内钉会增加患儿家庭的经济负担,但其具有创伤小、手术时间短、出血量小等优势,且术后并发症少,有利于患儿愈合,是不稳定性桡骨下段骨折患儿新的理想治疗方案。
Objective To investigate the clinical effect of minimally invasive double elastic intramedullary nail in the treatment of unstable distal radius fractures in children. Method 124 children with unstable distal radius fractures were treated in our hospital,all the children were divided into observation group( 62 cases) and control group( 62 cases) by random number method,the observation group was treated with minimally invasive double elastic intramedullary nail method,while the control group was treated with conventional open reduction and plate fixation,the operation time,blood loss,operation cost and fracture healing time of the two groups were observed and compared,all children were followed up for 12 months,the complications of nonunion,bone bridge formation,osteomyelitis,radial nerve injury and re fracture were compared between the two groups,according to the X-ray examination results were checked,the curative effect evaluation standard of Flynn intramedullary nail on fracture healing were evaluated at the same time,using Gartland and Werley wrist score of patients with wrist function evaluation. Results The amount of bleeding and operation time in the observation group were significantly lower than that in the control group,but the cost of surgery was significantly higher than that in control group,the differences were statistically significant( P < 0. 05),two groups of children with fracture healing time was no significant difference( P > 0. 05),the observation group with postoperative complication rate was 4. 8%. The control group were the postoperative complication rate was 6. 5%. The complication rate of two groups of children had no significant difference( P > 0. 05); two groups were compared with the postoperative healing and recovery of wrist function evaluation,there were no significant differences( P > 0. 05),but the observation group with the excellent rate of treatment was significantly higher than the control group children. The difference was statistically significant( P < 0. 05). Conclusion The ideal treatment effect of unstable distal radial fractures with minimally invasive double elastic intramedullary nail,while the use of double elastic intramedullary nail will increase the economic burden of family children,but it has little trauma,short operation time,bleeding volume and other advantages,and less postoperative complications,help children healing,treatment unstable distal radial fractures in children with new ideal.
Objective To investigate the clinical effect of minimally invasive double elastic intramedullary nail in the treatment of unstable distal radius fractures in children. Method 124 children with unstable distal radius fractures were treated in our hospital,all the children were divided into observation group( 62 cases) and control group( 62 cases) by random number method,the observation group was treated with minimally invasive double elastic intramedullary nail method,while the control group was treated with conventional open reduction and plate fixation,the operation time,blood loss,operation cost and fracture healing time of the two groups were observed and compared,all children were followed up for 12 months,the complications of nonunion,bone bridge formation,osteomyelitis,radial nerve injury and re fracture were compared between the two groups,according to the X-ray examination results were checked,the curative effect evaluation standard of Flynn intramedullary nail on fracture healing were evaluated at the same time,using Gartland and Werley wrist score of patients with wrist function evaluation. Results The amount of bleeding and operation time in the observation group were significantly lower than that in the control group,but the cost of surgery was significantly higher than that in control group,the differences were statistically significant( P < 0. 05),two groups of children with fracture healing time was no significant difference( P > 0. 05),the observation group with postoperative complication rate was 4. 8%. The control group were the postoperative complication rate was 6. 5%. The complication rate of two groups of children had no significant difference( P > 0. 05); two groups were compared with the postoperative healing and recovery of wrist function evaluation,there were no significant differences( P > 0. 05),but the observation group with the excellent rate of treatment was significantly higher than the control group children. The difference was statistically significant( P < 0. 05). Conclusion The ideal treatment effect of unstable distal radial fractures with minimally invasive double elastic intramedullary nail,while the use of double elastic intramedullary nail will increase the economic burden of family children,but it has little trauma,short operation time,bleeding volume and other advantages,and less postoperative complications,help children healing,treatment unstable distal radial fractures in children with new ideal.
引文
[1]魏红卫,苏朋伟,苗连峰.弹性髓钉在治疗儿童尺桡骨双骨折中的应用[J].当代医学,2017,94(10):111.
[2]Lee A K,Beck J D,Mirenda W M,et al.Incidence and risk factors for extensor pollicis longus rupture in elastic stable intramedullary nailing of pediatric forearm shaft fractures[J].Journal of Pediatric Orthopaedics,2016,36(8):810.
[3]徐蕴岚,沈恺颖,王志刚.弹性髓内钉在儿童长骨干骺交界区骨折中的治疗体会[J].中国矫形外科杂志,2016,24(16):1455.
[4]李宗起.切开复位内固定治疗桡骨远端不稳定性骨折疗效观察[J].山东医药,2014,44(34):46.
[5]Brooker B,Harris P C,Donnan L T,et al.Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children[J].Journal of children's orthopaedics,2014,8(4):353.
[6]Abosalim A A E A,El-Din A F S,El-Mowafy H M.Treatment of humeral shaft fractures by a single elastic stable intramedullary nail in children[J].Menoufia Medical Journal,2015,28(1):125.
[7]吕刚,孟庆才,苗德胜,等.弹性髓内钉与钢板置入修复儿童肱骨骨折的Meta分析[J].中国组织工程研究,2015,19(17):2782.
[8]缪杰佳,沈钊雄.桡骨远端骨折治疗策略及相关研究进展[J].医学研究生学报,2017,30(5):551.
[9]Varga M,Józsa G,Fadgyas B,et al.Short,double elastic nailing of severely displaced distal pediatric radial fractures:A new method for stable fixation[J].Medicine,2017,96(14):125.
[10]刘鹏.桡骨头骨折的手术内固定治疗[J].转化医学电子杂志,2016,3(8):9.
[11]郭永煜.锁定加压钢板内固定治疗四肢骨折中的临床体会[J].转化医学电子杂志,2016,3(8):22.
[12]刘国庆,王文己,时红萍,等.弹性髓内钉与钢板内固定修复前臂骨折疗效与安全性的Meta分析[J].中国组织工程研究,2014,18(26):4248.
[13]James D,Madhuri V.Safety,efficacy,and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children[J].Paediatric Orthopaedics and Related Sciences,2017,3(1):29.
[14]Fragomen A T,Rozbruch S R.Iatrogenic Deformities[M].Pediatric Lower Limb Deformities.Springer International Publishing,2016:605-621.
[15]杨明,武理国,马一平,等.微创双弹性髓内钉治疗儿童桡骨下段骨折[J].中华手外科杂志,2017,33(3):135.
[16]叶晖,林其仁,张小路,等.弹性髓内针单根骨折固定治疗儿童前臂双骨折[J].中华手外科杂志,2014,30(6):428.
[17]魏红卫,苏朋伟,苗连峰.弹性髓钉在治疗儿童尺桡骨双骨折中的应用[J].当代医学,2017,94(10):111.
[18]马一平,胡成挺,陈林,等.克氏针辅助复位弹性钉治疗儿童严重移位尺桡骨骨折[J].中国矫形外科杂志,2015,23(10):956.
[19]张鑫,罗聪,李明,等.弹性髓内钉与钢板治疗儿童尺桡骨双骨折的疗效比较[J].中华创伤杂志,2015,31(2):139.
[20]夏永杰.单、双根弹性髓内钉治疗大龄儿童尺桡骨双骨折的效果对比[J].现代诊断与治疗,2017,28(11):2111.
[2]Lee A K,Beck J D,Mirenda W M,et al.Incidence and risk factors for extensor pollicis longus rupture in elastic stable intramedullary nailing of pediatric forearm shaft fractures[J].Journal of Pediatric Orthopaedics,2016,36(8):810.
[3]徐蕴岚,沈恺颖,王志刚.弹性髓内钉在儿童长骨干骺交界区骨折中的治疗体会[J].中国矫形外科杂志,2016,24(16):1455.
[4]李宗起.切开复位内固定治疗桡骨远端不稳定性骨折疗效观察[J].山东医药,2014,44(34):46.
[5]Brooker B,Harris P C,Donnan L T,et al.Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children[J].Journal of children's orthopaedics,2014,8(4):353.
[6]Abosalim A A E A,El-Din A F S,El-Mowafy H M.Treatment of humeral shaft fractures by a single elastic stable intramedullary nail in children[J].Menoufia Medical Journal,2015,28(1):125.
[7]吕刚,孟庆才,苗德胜,等.弹性髓内钉与钢板置入修复儿童肱骨骨折的Meta分析[J].中国组织工程研究,2015,19(17):2782.
[8]缪杰佳,沈钊雄.桡骨远端骨折治疗策略及相关研究进展[J].医学研究生学报,2017,30(5):551.
[9]Varga M,Józsa G,Fadgyas B,et al.Short,double elastic nailing of severely displaced distal pediatric radial fractures:A new method for stable fixation[J].Medicine,2017,96(14):125.
[10]刘鹏.桡骨头骨折的手术内固定治疗[J].转化医学电子杂志,2016,3(8):9.
[11]郭永煜.锁定加压钢板内固定治疗四肢骨折中的临床体会[J].转化医学电子杂志,2016,3(8):22.
[12]刘国庆,王文己,时红萍,等.弹性髓内钉与钢板内固定修复前臂骨折疗效与安全性的Meta分析[J].中国组织工程研究,2014,18(26):4248.
[13]James D,Madhuri V.Safety,efficacy,and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children[J].Paediatric Orthopaedics and Related Sciences,2017,3(1):29.
[14]Fragomen A T,Rozbruch S R.Iatrogenic Deformities[M].Pediatric Lower Limb Deformities.Springer International Publishing,2016:605-621.
[15]杨明,武理国,马一平,等.微创双弹性髓内钉治疗儿童桡骨下段骨折[J].中华手外科杂志,2017,33(3):135.
[16]叶晖,林其仁,张小路,等.弹性髓内针单根骨折固定治疗儿童前臂双骨折[J].中华手外科杂志,2014,30(6):428.
[17]魏红卫,苏朋伟,苗连峰.弹性髓钉在治疗儿童尺桡骨双骨折中的应用[J].当代医学,2017,94(10):111.
[18]马一平,胡成挺,陈林,等.克氏针辅助复位弹性钉治疗儿童严重移位尺桡骨骨折[J].中国矫形外科杂志,2015,23(10):956.
[19]张鑫,罗聪,李明,等.弹性髓内钉与钢板治疗儿童尺桡骨双骨折的疗效比较[J].中华创伤杂志,2015,31(2):139.
[20]夏永杰.单、双根弹性髓内钉治疗大龄儿童尺桡骨双骨折的效果对比[J].现代诊断与治疗,2017,28(11):2111.