摘要
目的评价单臂外固定架治疗儿童桡骨远端干骺交界区骨折的临床疗效。方法回顾性分析2016年5月至2020年5月我院收治的桡骨远端干骺交界区骨折共计 73例,其中男58例,女15例;平均年龄 10.2 (6.2~15.1)岁;左侧49例,右侧24例;单纯桡骨骨折23例,尺桡骨双骨折50例。致伤原因:运动中摔伤 59 例,自行车摔伤6例,机动车撞伤4例,高处坠落伤4例。定期复查随访观察患儿骨折愈合情况、腕关节活动恢复情况及并发症情况,采用 Gartland-Werley 腕关节功能评分进行疗效评估。结果手术采用单纯外固定架固定38例,桡骨外固定架合并尺骨髓内针固定35例;54例骨折解剖复位,19例近解剖复位。73例患儿均获得平均13.5(6~24)个月随访;12 例针道感染,其中2例感染较重,Schanz 针略松动,分别于第6/8周骨折未完全愈合时提前拆除外固定架;临床愈合时间为 6~12 周,平均9.6周。所有患儿术后无血管、神经及肌腱损伤,无骨折再移位、骨折延迟愈合、不愈合、再骨折发生。末次随访时患肢腕关节各个方向活动角度均小于健侧,但两者对比差异无统计学意义 (P>0.05)。Gartland-Werley 腕关节功能评分结果显示优60例,良13例,优良率 100%。结论单臂外固定架治疗儿童桡骨远端干骺交界区骨折,具有操作简单、手术时间短、损伤少、固定牢固可靠、并发症少、不需要二次手术、腕关节功能恢复好等优点,是治疗该特殊类型骨折的有效方法。
Objective To evaluate the clinical efficacy of external fixator in the treatment of distal radial fractures involving metaphyseal diaphyseal junction in children.Methods A total of 73 patients (49 cases on the left,24 cases on the right) with distal radial fracture involving metaphyseal diaphyseal junction were treated by external fixation in Orthopedic Department of Beijing Children’s Hospital from May 2016 to May 2020,including 58 males and 15 females with an average age of 10.2 years (range:6.2 to 15.1 years).There were 23 cases of simple radius fracture and 50 cases of ulna and radius fractures.Causes of injury:59 cases of falling in sports;6 cases of falling in riding;4 cases of traffic injuries;4 cases of high falling.The healing,wrist range of motion and complications were observed.Garland-Werley was applied to evaluate wist functions.Results Among all patients,38 cases were fixed with external fixator alone and 35 cases were fixed with radius external fixator and ulna elastic stable intramedullary nail (ESIN).Anatomical reduction was achieved in 54 children,and proximal anatomical reduction was achieved in 19 children.All patients were followed up for 6.0-24.0 months with an average of 13.5 months.Pin infection occurred in 12 cases,and the fixed frame was removed at the 6th/8th week after operation due to loosening of Schanz needles in 2 cases.The clinical healing ranged 6-12 weeks with an average of 9.6 weeks.There was no vascular,nerve or tendon injury in all cases.No redisplacement,delayed union,nonunion or refracture occurred.The wrist range of motion in all directions were lower than that of the healthy side at the last follow-up,but no statistically significant differences were observed between the two sides (P > 0.05).The Gartland-Werley wrist function score showed excellent in 60 cases and good in 13 cases with the excellent and good rate of 100%.Conclusions External fixation will achieve good wrist function recovery without second operation by easy operation,less trauma,reliable fixation and fewer complications in the treatment of distal radial fractures involving metaphyseal diaphyseal junction in children.
作者
朱丹江
王强
宋宝健
冯伟
刘定武
ZHU Dan-jiang;WANG Qiang;SONG Bao-jian;FENG Wei;LIU Ding-wu(Department of Orthopedics,Beijing Children’s Hospital Affiliated to Capital Medical University,Beijing,100045,China)
出处
《中国骨与关节杂志》
CAS
2021年第3期192-197,共6页
Chinese Journal of Bone and Joint
基金
十三五国家重点研发计划基金(2020YFC1107604)。
关键词
桡骨骨折
儿童
骨折固定术
Radius fractures
Child
Fracture fixation
