术中肘关节造影辅助治疗低龄儿童桡骨颈骨折
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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 typeⅡand 7 cases of typeⅢ.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 21 months(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.
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 typeⅡand 7 cases of typeⅢ.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 21 months(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.
引文
[1]Hansen PE,Barnes DA,Tullos HS.Arthrographic diagnosis of an injury pattern in the distal humerus of an infant[J].J Pediatr Orthop,1982,2(5):569-572.
[2]Akbarnia BA,Silberstein MJ,Rende RJ,et al.Arthrography in the diagnosis of fractures of the distal end of the humerus in infants[J].J Bone Joint Surg(Am),1986,68(4):599-602.
[3]Yates C,Sullivan JA.Arthrographic diagnosis of elbow injuries in children[J].J Pediatr Orthop,1987,7(1):54-60.
[4]Abe M,Ishizu T,Nagaoka T,et al.Epiphyseal separation of the distal end of the humeral epiphysis:a follow-up note[J].J Pediatr Orthop,1995,15(4):426-434.
[5]Javed A,Guichet JM.Arthrography for reduction of a fracture of the radial neck in a child with a nonossified radialepiphysis[J].J Bone Joint Surg(Br),2001,83(4):542-543.
[6]Brand2o GF,Soares CB,Teixeira LE,et al.Displaced radial neck fractures in children:association of the Métaizeau and B9hler surgicaltechniques[J].J Pediatr Orthop,2010,30(2):110-114.
[7]Cha SM,Shin HD,Kim KC,et al.Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures[J].Int Orthop,2012,36(4):803-809.
[8]Cossio A,Cazzaniga C,Gridavilla G,et al.Paediatric radial neck fractures:One-step percutaneous reduction and fixation[J].Injury,2014,45(6):80-84.
[9]Song KS,Kim BS,Lee SW.Percutaneous leverage reduction for severely displaced radial neck fractures in children[J].J Pediatr Orthop,2015,35(4):26-30.
[10]龙虎成,王远辉,叶里子,等.经皮撬拨复位结合弹性髓内钉治疗儿童桡骨颈骨折[J].实用骨科杂志,2016,22(1):58-61.
[11]王鑫,赵亮,高广辉,等.经皮撬拨复位克氏针内固定治疗儿童桡骨颈骨折[J].中华手外科杂志,2015,31(4):307-308.
[12]沈先涛,陈小亮,李雄涛,等.B型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折[J].中华小儿外科杂志,2015,36(5):363-366.
[13]苏振炎,王来喜,曹亚伟.切开复位内固定治疗儿童桡骨颈骨折[J].中国骨与关节损伤杂志,2016,31(5):547-548.
[14]潘洪阁,牛会彬,刘中国.两种方式治疗O’BIRENⅡ、Ⅲ型儿童桡骨颈骨折[J].实用骨科杂志,2013,19(10):932-934.
[15]Jiang H,Wu Y,Dang Y,et al.Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report[J].Medicine(Baltimore),2017,96(1):e5806.
[16]姜海,李敏,吴永涛,等.术中肘关节造影辅助经皮撬拨复位克氏针内固定治疗儿童桡骨颈骨折[J].中国骨与关节杂志,2017,6(7):517-521.
[2]Akbarnia BA,Silberstein MJ,Rende RJ,et al.Arthrography in the diagnosis of fractures of the distal end of the humerus in infants[J].J Bone Joint Surg(Am),1986,68(4):599-602.
[3]Yates C,Sullivan JA.Arthrographic diagnosis of elbow injuries in children[J].J Pediatr Orthop,1987,7(1):54-60.
[4]Abe M,Ishizu T,Nagaoka T,et al.Epiphyseal separation of the distal end of the humeral epiphysis:a follow-up note[J].J Pediatr Orthop,1995,15(4):426-434.
[5]Javed A,Guichet JM.Arthrography for reduction of a fracture of the radial neck in a child with a nonossified radialepiphysis[J].J Bone Joint Surg(Br),2001,83(4):542-543.
[6]Brand2o GF,Soares CB,Teixeira LE,et al.Displaced radial neck fractures in children:association of the Métaizeau and B9hler surgicaltechniques[J].J Pediatr Orthop,2010,30(2):110-114.
[7]Cha SM,Shin HD,Kim KC,et al.Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures[J].Int Orthop,2012,36(4):803-809.
[8]Cossio A,Cazzaniga C,Gridavilla G,et al.Paediatric radial neck fractures:One-step percutaneous reduction and fixation[J].Injury,2014,45(6):80-84.
[9]Song KS,Kim BS,Lee SW.Percutaneous leverage reduction for severely displaced radial neck fractures in children[J].J Pediatr Orthop,2015,35(4):26-30.
[10]龙虎成,王远辉,叶里子,等.经皮撬拨复位结合弹性髓内钉治疗儿童桡骨颈骨折[J].实用骨科杂志,2016,22(1):58-61.
[11]王鑫,赵亮,高广辉,等.经皮撬拨复位克氏针内固定治疗儿童桡骨颈骨折[J].中华手外科杂志,2015,31(4):307-308.
[12]沈先涛,陈小亮,李雄涛,等.B型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折[J].中华小儿外科杂志,2015,36(5):363-366.
[13]苏振炎,王来喜,曹亚伟.切开复位内固定治疗儿童桡骨颈骨折[J].中国骨与关节损伤杂志,2016,31(5):547-548.
[14]潘洪阁,牛会彬,刘中国.两种方式治疗O’BIRENⅡ、Ⅲ型儿童桡骨颈骨折[J].实用骨科杂志,2013,19(10):932-934.
[15]Jiang H,Wu Y,Dang Y,et al.Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report[J].Medicine(Baltimore),2017,96(1):e5806.
[16]姜海,李敏,吴永涛,等.术中肘关节造影辅助经皮撬拨复位克氏针内固定治疗儿童桡骨颈骨折[J].中国骨与关节杂志,2017,6(7):517-521.