Wang Wei,Xu Wenqiang,Liu Chaoyu,et al.Clinical application of modified Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nail for children with Judet Ⅳ radial neck fracture[J].Journal of Clinical Pediatric Surgery,2021,20(08):766-772.[doi:10.12260/lcxewkzz.2021.08.012]
改良克氏针经皮旋转撬拨复位联合弹性髓内钉固定在儿童Judet Ⅳ型桡骨颈骨折中的应用研究
- Title:
- Clinical application of modified Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nail for children with Judet Ⅳ radial neck fracture
- Keywords:
- Radial Neck Fracture; Percutaneous Prying Reduction; Elastic Intramedullary Nail; Fracture Fixation; Child
- 分类号:
- R683.415;R726.8
- 摘要:
- 目的 探讨应用改良克氏针经皮旋转撬拨复位联合弹性髓内钉固定治疗儿童Judet Ⅳ型桡骨颈骨折的可行性与早期治疗效果。方法 回顾性收集2019年4月至2020年10月由阜阳市人民医院应用改良克氏针经皮旋转撬拨复位联合弹性髓内钉治疗的23例儿童Judet Ⅳ型桡骨颈骨折患者作为研究对象，其中男15例，女8例，年龄5~14岁，平均9.4岁；受伤至手术时间1~4 d，平均2.3 d；左侧13例，右侧10例；单纯桡骨颈骨折15例，合并尺骨近端骨折7例，合并肱骨内上髁骨折1例。按Judet分型：Ⅳa型15例，Ⅳb型8例；移位成角82.3°（72°~90°）。记录手术时间、透视次数、复位次数、按照Metaizeau放射学标准评价复位质量，末次随访时记录患侧和健侧肘关节屈伸及前臂旋转功能，并进行统计分析。结果 23例患者均应用此方法治疗，手术时间15~36 min，平均22 min；复位次数1~3次，平均1.3次；平均透视次数7.2次（范围：5~12次），按照Metaizeau放射学标准评估复位质量，优21例，良2例，优良率为100％，术后长臂石膏固定3~4周后行肘关节及前臂旋转功能锻炼。术后2~5个月骨折愈合满意后取出弹性髓内钉。所有患者获得随访，随访时间4~21个月，平均随访10.5个月。末次随访患肢按Metaizeau放射学标准评估复位质量：优22例，良1例，优良率为100%，患肢屈、伸、旋前、旋后范围分别为（141.09±3.64）°、（4.91±2.63）°、（85.61±2.87）°和（86.26±2.94）°，与健侧（141.83±1.92）°、（5.40±1.27）°、（86.13±1.42）°和（86.83 ±1.72）°比较，差异均无统计学意义（P>0.05）。随访时无一例发生感染、骨折再移位、骨不愈合、畸形愈合、交叉愈合、骨骺早闭及桡神经损伤等并发症。结论 改良克氏针经皮旋转撬拨复位联合弹性髓内钉技术治疗儿童移位严重的桡骨颈Judet Ⅳ型骨折，具有取材方便、操作简单、容易"捕获"明显移位的桡骨头、快速精准复位、减少辐射暴露、并发症少等优点，早期可获得满意的临床疗效。
- Abstract:
- Objective To explore the feasibility and early clinical outcome of applying modified Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nail for Judet Ⅳ radial neck fracture in children. Methods From April 2019 to October 2020, retrospective analysis was performed for 23 children with Judet Ⅳ radial neck fracture. There were 15 boys and 8 girls with an age range of 5-14 years. Time from injury to operation was 1-4 days. The involved side was left (n=13) and right (n=10). There were simple radius neck fractures (n=15), proximal ulnar fractures (n=7) and concurrent fracture of internal humeral epicondyle (n=1). According to the Judet classification scheme, the clinical types were Ⅳa (n=15) and Ⅳb (n=8). The degree of displacement was 82.3°(72°-90°). Operative duration, number of fluoroscopy, and frequency of reduction were recorded. The quality of reduction was evaluated according to Metaizeau radiological standards during the last follow-up. Flexion of elbow joint and rotation of forearm at both sides were recorded and statistical analysis was performed. Results The average operative duration was 22 min, the average number of reductions 1.3(1-3) and the average number of fluoroscopy 7.2 (5-12). According to the Metaizeau radiological standard, the outcomes were excellent (n=21) and decent (n=2). Elbow joint and forearm rotation function exercises were performed after long-arm plaster fixation for 3-4 weeks. Nail was extracted after satisfactory healing at Month 2-5 post-operation. The average follow-up period was 10.5(4-21) months. At the last follow-up, elbow joint was evaluated by the Metaizeau’s criteria. The outcomes were excellent (n=22) and decent (n=1). The ranges of flexion, extension, pronation and supination of affected side were (141.09ed ges of flexion, extension, pron, 86.269ed ges) versus those of healthy side (141.83th flexion, exte. 27°, 86.13°±1.42°, 86.83°±1.72°). The differences were not statistically different (P>0.05). During follow-ups, there was no occurrence of infection, fracture displacement, bone nonunion, malunion, cross union, premature closure of epiphysis or radial nerve injury. Conclusion The modified approach of Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nailing is efficacious for children with severely displaced radial neck Judet Ⅳ fractures. It offers the advantages of convenient material supply, simple handling, easier "capturing" of obviously displaced radial head, faster precision reduction, lowered radiation exposure, fewer complications and satisfactory immediate efficacies.
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相似文献/References:
[1]吴世强,徐杰,林其仁,等.儿童桡骨颈骨折预后的影响因素分析[J].临床小儿外科杂志,2017,16(03):233.
备注/Memo
收稿日期:2021-02-25。
基金项目:安徽省阜阳市自筹经费科技计划项目（编号：FK202081026）
作者简介:王伟,Email:fywangwei0558@163.com