手法复位小夹板固定治疗儿童尺桡骨远端骨折背侧移位
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摘要
目的:观察挤压、折顶、摇摆手法复位小夹板固定治疗儿童尺桡骨远端骨折背侧移位的临床疗效及安全性。方法:2012年8月至2017年8月,采用挤压、折顶、摇摆手法复位小夹板固定治疗儿童尺桡骨远端骨折背侧移位患者21例。男14例,女7例。年龄4～13岁,中位数7岁。左侧9例,右侧12例。合并正中神经损伤7例。受伤至本次治疗时间0. 5～48 h,中位数24 h。参照《骨与关节损伤》中骨折复位标准评定复位效果,采用Mehara等制定的腕关节Barton骨折疗效标准评定综合疗效,随访观察不良反应发生情况。结果:本组21例患者中,1次复位成功17例,2次复位成功3例,复位失败1例。复位失败的1例患者,采用经皮撬拨复位克氏针固定术治疗。复位治疗结束后按照上述复位标准评定复位效果,解剖复位10例、近解剖复位6例、功能复位5例。所有患者均获6个月的随访,骨折均愈合。随访期间3例出现骨折端再移位,再次手法复位小夹板固定,最终骨折愈合良好。末次随访时采用上述疗效标准评定综合疗效,优17例、良3例、可1例。合并正中神经损伤的7例患者,神经损伤症状均自然消失。治疗过程中及随访期间,所有患者均未出现神经或血管损伤、骨筋膜室综合征及缺血性肌挛缩。结论:挤压、折顶、摇摆手法复位小夹板固定治疗儿童尺桡骨远端骨折背侧移位,1次复位成功率高、复位效果好、骨折愈合好、综合疗效好、安全性高,值得临床推广应用。
引文
[1]赵俊峰,张天健,高泉阳,等.正骨手法复位治疗儿童尺桡骨下段背向移位骨折[J].中国骨伤,2017,30(7):664-668.
[2]HOVE L M,BRUDVIK C.Displaced paediatric fractures of the distal radius[J].Arch Orthop Trauma Surg,2008,128(1):55-60.
[3]RAMOUTAR D N,SHIVJI F S,RODRIGUES J N,et al.The outcomes of displaced paediatric distal radius fractures treated with percutaneous Kirschner wire fixation:a review of 248 cases[J].Eur J Orthop Surg Traumatol,2015,25(3):471-476.
[4]刘智.桡骨远端骨折治疗方法的合理选择[J].中国骨伤,2010,23(8):571-573.
[5]郑晓蓉,钟黎娟,萧庆瑞,等.回旋手法为主整复尺桡骨下段骨折[J].中国骨伤,2012,25(10):875-876.
[6]张新武,邹卫兵,江平频,等.回旋折顶法治疗儿童尺桡骨远端背向移位骨折[J].临床医学工程,2012,19(4):587-588.
[7]王亦璁.骨与关节损伤[M].3版.北京:人民卫生出版社,2001:59-62.
[8]MEHARA A K,RASTOGI S,BHAN S,et al.Classification and treatment of volar Barton fractures[J].Injury,1993,24(1):55-59.
[9]BEATY J H,KASSER J R.洛克伍德、威尔金斯儿童骨折[M].王家让,李康华,胡建中,译.5版.长沙:湖南科学技术出版社,2005:386.
[10]李广文.回旋复位配合小夹板固定治疗儿童尺桡骨远端双骨折背向移位32例[J].山西中医,2011,27(7):29.
[11]周晓宁.腕关节三维有限元模型的建立及桡骨远端骨折发生机制的生物力学分析[D].北京:北京中医药大学,2014.
[12]伍栋材.儿童桡尺骨远端骨折背侧移位的分型论治初探[J].中医正骨,2000,12(11):23-24.
[13]COLARIS J,REIJMAN M,ALLEMA J H,et al.Angular malalignment as cause of limitation of forearm rotation:an analysis of prospectively collected data of both-bone forearm fractures in children[J].Injury,2014,45(6):955-959.
[14]YASUTOMI T,NAKATSUCHI Y,KOIKE H,et al.Mechanism of limitation of pronation/supination of the forearm in geometric models of deformities of the forearm bones[J].Clin Biomech(Bristol,Avon),2002,17(6):456-463.
[15]VAN LEEMPUT W,DE RIDDER K.Distal metaphyseal radius fractures in children:reduction with or without pinning[J].Acta Orthop Belg,2009,75(3):306-309.
[16]JORDAN R W,WESTACOTT D J.Displaced paediatric distal radius fractures-when should we use percutaneous wires?[J].Injury,2012,43(6):908-911.
[17]PANERU S R,RIJAL R,SHRESTHA B P,et al.Randomized controlled trial comparing above-and below-elbow plaster casts for distal forearm fractures in children[J].JChild Orthop,2010,4(3):233-237.
[18]ASADOLLAHI S,POURALI M,HEIDARI K.Predictive factors for re-displacement in diaphyseal forearm fractures in children-role of radiographic indices[J].Acta Orthop,2017,88(1):101-108.
[2]HOVE L M,BRUDVIK C.Displaced paediatric fractures of the distal radius[J].Arch Orthop Trauma Surg,2008,128(1):55-60.
[3]RAMOUTAR D N,SHIVJI F S,RODRIGUES J N,et al.The outcomes of displaced paediatric distal radius fractures treated with percutaneous Kirschner wire fixation:a review of 248 cases[J].Eur J Orthop Surg Traumatol,2015,25(3):471-476.
[4]刘智.桡骨远端骨折治疗方法的合理选择[J].中国骨伤,2010,23(8):571-573.
[5]郑晓蓉,钟黎娟,萧庆瑞,等.回旋手法为主整复尺桡骨下段骨折[J].中国骨伤,2012,25(10):875-876.
[6]张新武,邹卫兵,江平频,等.回旋折顶法治疗儿童尺桡骨远端背向移位骨折[J].临床医学工程,2012,19(4):587-588.
[7]王亦璁.骨与关节损伤[M].3版.北京:人民卫生出版社,2001:59-62.
[8]MEHARA A K,RASTOGI S,BHAN S,et al.Classification and treatment of volar Barton fractures[J].Injury,1993,24(1):55-59.
[9]BEATY J H,KASSER J R.洛克伍德、威尔金斯儿童骨折[M].王家让,李康华,胡建中,译.5版.长沙:湖南科学技术出版社,2005:386.
[10]李广文.回旋复位配合小夹板固定治疗儿童尺桡骨远端双骨折背向移位32例[J].山西中医,2011,27(7):29.
[11]周晓宁.腕关节三维有限元模型的建立及桡骨远端骨折发生机制的生物力学分析[D].北京:北京中医药大学,2014.
[12]伍栋材.儿童桡尺骨远端骨折背侧移位的分型论治初探[J].中医正骨,2000,12(11):23-24.
[13]COLARIS J,REIJMAN M,ALLEMA J H,et al.Angular malalignment as cause of limitation of forearm rotation:an analysis of prospectively collected data of both-bone forearm fractures in children[J].Injury,2014,45(6):955-959.
[14]YASUTOMI T,NAKATSUCHI Y,KOIKE H,et al.Mechanism of limitation of pronation/supination of the forearm in geometric models of deformities of the forearm bones[J].Clin Biomech(Bristol,Avon),2002,17(6):456-463.
[15]VAN LEEMPUT W,DE RIDDER K.Distal metaphyseal radius fractures in children:reduction with or without pinning[J].Acta Orthop Belg,2009,75(3):306-309.
[16]JORDAN R W,WESTACOTT D J.Displaced paediatric distal radius fractures-when should we use percutaneous wires?[J].Injury,2012,43(6):908-911.
[17]PANERU S R,RIJAL R,SHRESTHA B P,et al.Randomized controlled trial comparing above-and below-elbow plaster casts for distal forearm fractures in children[J].JChild Orthop,2010,4(3):233-237.
[18]ASADOLLAHI S,POURALI M,HEIDARI K.Predictive factors for re-displacement in diaphyseal forearm fractures in children-role of radiographic indices[J].Acta Orthop,2017,88(1):101-108.