弹性髓内钉治疗儿童尺桡骨双骨骨折45例（英文）
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摘要
目的评价应用弹性髓内钉(elastic intramedulary,ESIN)治疗儿童(4~15岁)尺桡骨双骨骨折疗效.方法回顾分析2008年4月至2014年6月45例儿童尺桡骨双骨骨折患儿使用ESIN治疗.分析讨论手术技巧、术后治疗效果及并发症。术后随访分别于3个月、6个月,12个月36个月对患儿患肢进行X线拍片及前臂功能评分.结果随访24~30个月,45名患儿中愈合程度优38例,良7例.骨折愈合时间3~8个月,出现针尾皮肤激惹9例、术后骨折端轻度侧方移位3例、尺骨折延迟愈合1例.所有病例骨折端侧位对位率>50%,前后位对位率>90%.未出现ESIN折断、神经损伤、术后骨折严重移位、骨不连、严重软组织感染等并发症.结论应用ESIN治疗儿童尺桡骨双骨骨折是一种安全可行的手术方式,其具有手术技术要不高,创伤小,手术并发症少,不影响儿童骨骼生长、前臂功能恢复好等优点.
Objective To evaluate the clinical outcome and discuss the method of treatment both-bone forearm fracture in children(4 to 15 years old) with elastic intramedullary nail(EIN). Methods We retrospectively analyzed the clinical result of forty-five cases to treat both-bone forearm fracture in children(4 to 15 years old) with elastic intramedullary nail from April,2008 to June,2014.Then we Discussed and analyzed the complication, surgery technique, limb function. Patients were followed up for more than 24 to 30 months after the surgery to continuously evaluate the limb function and fracture healing by physical examination and x-ray image.Results There were 38 children with excellent recovery,7 good and no fair by followed up for 24 to 30 months,9 cases with observed complication due by prominent nail ends, 3 patients slightly declined after the surgery, 1 patient was observed with ulna fracture delayed recovery during 3 to 8 months of fracture healing. Apposition rate in all cases was>50% in anterior-posterior view and the apposition rate>90% in lateral view. No fracture of ESIN,Nerve injuries, severe displacement were observed during this study. Conclusion The elastic intramedullary nail is a good method to treat children both-bone forearm fracture with lower surgery technique, minimall invasion,if less complications,does not interfere with growth,has good forearm function recovery.
Objective To evaluate the clinical outcome and discuss the method of treatment both-bone forearm fracture in children(4 to 15 years old) with elastic intramedullary nail(EIN). Methods We retrospectively analyzed the clinical result of forty-five cases to treat both-bone forearm fracture in children(4 to 15 years old) with elastic intramedullary nail from April,2008 to June,2014.Then we Discussed and analyzed the complication, surgery technique, limb function. Patients were followed up for more than 24 to 30 months after the surgery to continuously evaluate the limb function and fracture healing by physical examination and x-ray image.Results There were 38 children with excellent recovery,7 good and no fair by followed up for 24 to 30 months,9 cases with observed complication due by prominent nail ends, 3 patients slightly declined after the surgery, 1 patient was observed with ulna fracture delayed recovery during 3 to 8 months of fracture healing. Apposition rate in all cases was>50% in anterior-posterior view and the apposition rate>90% in lateral view. No fracture of ESIN,Nerve injuries, severe displacement were observed during this study. Conclusion The elastic intramedullary nail is a good method to treat children both-bone forearm fracture with lower surgery technique, minimall invasion,if less complications,does not interfere with growth,has good forearm function recovery.
引文
[1]KHOSLA S,MELTON L J,3RD,DEKUTOSKI M B,et al.Incidence of childhood distal forearm fractures over 30years:a population-based study[J].Jama,2003,290(11):1479-1485.
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[3]MILLER B S,TAYLOR B,WIDMANN R F,et al.Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children:a prospective,randomized study[J].Journal of Pediatric Orthopedics,2005,25(4):490-494.
[4]LIGIER J N,METAIZEAU J P,PREVOT J,et al.Elastic stable intramedullary nailing of femoral shaft fractures in children[J].The Journal of Bone and Joint Surgery British Volume,1988,70(1):74-77.
[5]FERNANDEZ F F,EGENOLF M,CARSTEN C,et al.Unstable diaphyseal fractures of both bones of the forearm in children:plate fixation versus intramedullary nailing[J].Injury,2005,36(10):1210-1216.
[6]ANDERSON L D,SISK D,TOOMS R E,et al.Compression-plate fixation in acute diaphyseal fractures of the radius and ulna[J].The Journal of Bone and Joint Surgery American Volume,1975,57(3):287-297.
[7]MCHENRY T P,PIERCE W A,LAIS R L,et al.Effect of displacement of ulna-shaft fractures on forearm rotation:a cadaveric model[J].American Journal of Orthopedics(Belle Mead,NJ),2002,31(7):420-424.
[8]SARMIENTO A,EBRAMZADEH E,BRYS D,et al.Angular deformities and forearm function[J].Journal of OrThopaedicresearch:Official Publication of the Orthopaedic Research Society,1992,10(1):121-133.
[9]HANG J R,HUTCHINSON A F,HAU R C.Risk factors associated with loss of position after closed reduction of distal radial fractures in children[J].Journal of pediatric orthopedics,2011,31(5):501-506.
[10]LASCOMBES P,HUBER H,FAY R,et al.Flexible intramedullary nailing in children:nail to medullary canal diameters optimal ratio[J].Journal of Pediatric Orthopedics,2013,33(4):403-408.
[11]LASCOMBES P,PREVOT J,LIGIER J N,et al.Elastic stable intramedullary nailing in forearm shaft fractures in children:85 cases[J].Journal of Pediatric Orthopedics,1990,10(2):167-171.
[12]FLYNN J M,JONES K J,GARNER M R,et al.Eleven years experience in the operative management of pediatric forearm fractures[J].Journal of Pediatric Orthopedics,2010,30(4):313-319.
[13]FLYNN J M,HRESKO T,REYNOLDS R A,et al.Titanium elastic nails for pediatric femur fractures:a multicenter study of early results with analysis of complications[J].Journal of Pediatric Orthopedics,2001,21(1):4-8.
[14]TILL H,HUTTL B,KNORR P,et al.Elastic stable intramedullary nailing(ESIN)provides good long-term results in pediatric long-bone fractures[J].European journal of pediatric surgery:official journal of Austrian Association of Pediatric Surgery,2000,10(5):319-322.
[15]LU B,LIU P,WANG Y.Application of elastic intramedullary nail in the treatment of both ulna and radius fractures in children[J].Zhonghuayixuezazhi,2014,94(24):1882-1885.
[16]ZHANG X I N,LUO CONG,LI MING,et al.Comparison of the curative effect of elastic intramedullary nail and plate in the treatment of children with ulnar radius fractures[J].Chinese Journal of Traumatology,20(2):139-142.
[17]SINIKUMPU J J,KERANEN J,HALTIA A M,et al.Anew mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing:a pre liminary technical report[J].Scandinavian Journal of Surgery:SJS:Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society,2013,102(4):258-264.
[2]JONES I E,WILLIAMS S M,DOW N,et al.How many children remain fracture-free during growth a longitudinal study of children and adolescents participating in the dunedin multidisciplinary health and development study[J].Osteoporosis international:A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA,2002,13(12):990-995.
[3]MILLER B S,TAYLOR B,WIDMANN R F,et al.Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children:a prospective,randomized study[J].Journal of Pediatric Orthopedics,2005,25(4):490-494.
[4]LIGIER J N,METAIZEAU J P,PREVOT J,et al.Elastic stable intramedullary nailing of femoral shaft fractures in children[J].The Journal of Bone and Joint Surgery British Volume,1988,70(1):74-77.
[5]FERNANDEZ F F,EGENOLF M,CARSTEN C,et al.Unstable diaphyseal fractures of both bones of the forearm in children:plate fixation versus intramedullary nailing[J].Injury,2005,36(10):1210-1216.
[6]ANDERSON L D,SISK D,TOOMS R E,et al.Compression-plate fixation in acute diaphyseal fractures of the radius and ulna[J].The Journal of Bone and Joint Surgery American Volume,1975,57(3):287-297.
[7]MCHENRY T P,PIERCE W A,LAIS R L,et al.Effect of displacement of ulna-shaft fractures on forearm rotation:a cadaveric model[J].American Journal of Orthopedics(Belle Mead,NJ),2002,31(7):420-424.
[8]SARMIENTO A,EBRAMZADEH E,BRYS D,et al.Angular deformities and forearm function[J].Journal of OrThopaedicresearch:Official Publication of the Orthopaedic Research Society,1992,10(1):121-133.
[9]HANG J R,HUTCHINSON A F,HAU R C.Risk factors associated with loss of position after closed reduction of distal radial fractures in children[J].Journal of pediatric orthopedics,2011,31(5):501-506.
[10]LASCOMBES P,HUBER H,FAY R,et al.Flexible intramedullary nailing in children:nail to medullary canal diameters optimal ratio[J].Journal of Pediatric Orthopedics,2013,33(4):403-408.
[11]LASCOMBES P,PREVOT J,LIGIER J N,et al.Elastic stable intramedullary nailing in forearm shaft fractures in children:85 cases[J].Journal of Pediatric Orthopedics,1990,10(2):167-171.
[12]FLYNN J M,JONES K J,GARNER M R,et al.Eleven years experience in the operative management of pediatric forearm fractures[J].Journal of Pediatric Orthopedics,2010,30(4):313-319.
[13]FLYNN J M,HRESKO T,REYNOLDS R A,et al.Titanium elastic nails for pediatric femur fractures:a multicenter study of early results with analysis of complications[J].Journal of Pediatric Orthopedics,2001,21(1):4-8.
[14]TILL H,HUTTL B,KNORR P,et al.Elastic stable intramedullary nailing(ESIN)provides good long-term results in pediatric long-bone fractures[J].European journal of pediatric surgery:official journal of Austrian Association of Pediatric Surgery,2000,10(5):319-322.
[15]LU B,LIU P,WANG Y.Application of elastic intramedullary nail in the treatment of both ulna and radius fractures in children[J].Zhonghuayixuezazhi,2014,94(24):1882-1885.
[16]ZHANG X I N,LUO CONG,LI MING,et al.Comparison of the curative effect of elastic intramedullary nail and plate in the treatment of children with ulnar radius fractures[J].Chinese Journal of Traumatology,20(2):139-142.
[17]SINIKUMPU J J,KERANEN J,HALTIA A M,et al.Anew mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing:a pre liminary technical report[J].Scandinavian Journal of Surgery:SJS:Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society,2013,102(4):258-264.