Hu Wenfeng,Li Tianyou,Wang Yanzhou,et al.Nonunion of distal radius fractures in children:a report of three cases with a literature review[J].Journal of Clinical Pediatric Surgery,2022,21(12):1179-1184.[doi:10.3760/cma.j.cn101785-202105060-015]
儿童桡骨远端骨折不愈合3例并文献复习
- Title:
- Nonunion of distal radius fractures in children:a report of three cases with a literature review
- Keywords:
- Radius Fractures; Orthopedic Procedures; Treatment Outcome; Child
- 摘要:
- 目的 探讨儿童桡骨远端骨折不愈合的好发部位及原因。方法 回顾性分析2013年5月至2021年3月山东第一医科大学附属省立医院收治的3例儿童桡骨远端骨折不愈合患儿临床资料;通过PubMed、万方医学网、中国知网检索2021年3月前的相关文献,总结分析本院以及纳入文献中病例的性别、年龄、骨折类型、治疗方式等特点。结果 本院3例初始均行切开复位克氏针内固定术,骨折未愈合,2例行再手术,愈合良好;1例未再手术。共检索到5篇相关文献8例患儿,联合本中心3例,共11例纳入研究。其中男9例,女2例,平均年龄8岁11个月(6~13岁);初次治疗时骨折均完全移位,且合并尺骨远端骨折;6例未注明侧别,其余5例中左侧4例,右侧1例;7例行切开复位克氏针内固定术,2例行切开复位钢板内固定术,2例行闭合复位石膏固定术。10例因骨不愈合再次手术,均愈合良好,其中切开复位自体髂骨植骨6例,包括钢板固定3例,外固定架、克氏针、单纯石膏固定各1例;切开复位钢板内固定3例;闭合复位克氏针内固定1例。按照Lieber标准,1例为干骺端骨折,10例为骨干与干骺端交界区骨折。结论 儿童桡骨远端骨折不愈合好发于骨干与干骺端交界区,该交界区骨折需充分认识和谨慎处理,若行切开手术,建议解剖复位、稳定固定、密切随访。
- Abstract:
- Objective To explore the predilection sites and causes of distal radius nonunion in children.Methods From May 2013 to March 2021,clinical data were retrospectively reviewed for three children with nonunion of distal radius fracture.The relevant literatures were retrieved from the databases of PubMed,WanFang and CNKI prior to March 2021.Gender,age,fracture type and treatment option were analyzed.Results Open reduction and Kirschner wire fixation were performed initially.Nonunion occurred after ineffective conservative treatment.Two cases were re-operated and healed while another one case refused any further intervention.By searching the database,5 relevant items (8 cases) were included.Altogether there were 9 boys and 2 girls with an average age of 107(72-156) months.All fractures were totally displaced with distal ulna fracture.The involved side was left (n=4),right (n=2) and unknown (n=6).Open reduction plus Kirschner wire fixation (n=7),open reduction plus plate fixation (n=1) and closed reduction with cast immobilization (n=2) were performed.Ten patients were re-operated due to nonunion and healed during follow-ups.Six cases underwent open reduction plus autologous iliac bone graft,including plate fixation (n=3),external fixator (n=1),Kirschner wire (n=1) and casting (n=1).Open reduction plus plate fixation (n=3) and closed reduction plus Kirschner wire fixation (n=1) were performed.According to the Lieber’s criteria,there were epiphyseal fracture (n=1) and diametaphyseal fractures (n=10).Conclusion Distal radius nonunion affects mostly diametaphyseal area.To prevent nonunion,more attention should be focused upon this area.For open reduction,anatomical reduction plus stable fixation should be considered along with close follow-ups.
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备注/Memo
收稿日期:2021-5-31。
基金项目:国家重点研发计划(2016YFC0901503)
通讯作者:李天友,Email:tianyouli1983@126.com