Meng Ge,Yuan Yue,Yuan Liang,et al.Efficacy of antegrade elastic intramedullary nailing for severely displaced unstable distal radial metaphyseal junction fracture in children[J].Journal of Clinical Pediatric Surgery,2025,(09):872-876.[doi:10.3760/cma.j.cn101785-202211011-013]
顺行弹性髓内钉治疗严重移位的儿童不稳定桡骨远端干骺交界区骨折
- Title:
- Efficacy of antegrade elastic intramedullary nailing for severely displaced unstable distal radial metaphyseal junction fracture in children
- 摘要:
- 目的 初步探讨顺行弹性髓内钉治疗严重移位的儿童不稳定桡骨远端干骺交界区骨折临床疗效。方法 回顾性分析2020年7月至2022年3月安徽省儿童医院骨科采用顺行弹性髓内钉内固定治疗的46例严重移位的不稳定桡骨远端干骺交界区骨折患儿资料。受伤机制：玩耍跌伤39例，高处坠落伤3例，交通事故伤4例；男41例、女5例，年龄(9.93±2.67)岁；左侧23例, 右侧23例；闭合性骨折44例，开放性骨折2例(充分预防性抗感染后予以手术治疗)；单纯桡骨骨折9例，合并尺骨远端骨折37例；受伤至手术时间1~16 d(平均3.4 d)。记录分析患儿手术时间、术中透视次数、住院天数、去除石膏时间；随访患儿骨折术后并发症、前臂及腕关节活动度，采用Anderson前臂骨折功能评定标准进行疗效评估。结果 本组病例手术时间(61.91±27.89)min，术中透视次数(20.87±7.43)次，住院天数(4.96±1.98)d，去除石膏时间为术后(4.24±0.82)周。随访(7.98±2.32)个月，其中5例出现并发症：3例钉尾激惹，1例骨折移位，1例出现桡神经损伤；无一例骨折延迟愈合、不愈合。46例均获完整随访，末次随访时健侧前臂旋前角度(88.67±3.20)°、前臂旋后角度(85.67±4.74)°、腕关节掌屈角度(62.22±8.76)°、腕关节背伸角度(67.15±7.42)°、腕关节尺侧倾斜角度(31.40±4.23)°、腕关节桡侧倾斜角度(21.26±3.06)°；患侧前臂旋前角度(84.76±4.86)°、前臂旋后角度(84.28±4.79)°、腕关节掌屈角度(62.67±8.83)°、腕关节背伸角度(66.65±7.38)°、腕关节尺侧倾斜角度(31.69±3.85)°、腕关节桡侧倾斜角度(20.89±2.57)°；患肢前臂旋前、旋后角度小于健侧，但差异均无统计学意义(P＞0.05)。末次随访时Anderson前臂骨折功能评价结果：优44例，良2例。结论 顺行弹性髓内钉治疗严重移位的不稳定儿童桡骨远端干骺交界区骨折具有不损伤骨骺、术后并发症少、功能恢复良好等优点，是治疗该特殊类型骨折的有效方法。
- Abstract:
- Objective To explore the clinical efficacy of antegrade elastic intramedullary nailing for severely displaced unstable distal radial metaphyseal junction fracture in children. Methods Retrospective analysis was performed for the relevant clinical data of 46 children with severely displaced unstable distal radial metaphyseal junction fracture undergoing anterograde elastic intramedullary nailing from July 2020 to March 2022.The causes of injury were frolicking falls (n=39), falling from heights (n=3) and traffic accidents (n=4).There were 41 boys and 5 girls with an average age of (9.93±2.67) year.The affected side was left (n=23) and right (n=23).The fractures were closed (n=44) and open (n=2) (surgery after adequate preventive anti-infection).Radial fractures were simple (n=9) and combined with distal ulnar fractures (n=37).Time from injury to surgery was 3.4(1-16) day.Operative duration, number of intraoperative fluoroscopy sessions, length of hospitalization stay and removal time for plaster cast were recorded.The postoperative complications of fractures and the ranges of motion of forearm and wrist joints were followed up.And therapeutic effect was evaluated with the Anderson functional assessment criteria for forearm fractures. Results In this cohort, operative duration was (61.91±27.89) min, number of intraoperative fluoroscopy (20.87±7.43) sessions, length of hospitalization (4.96±1.98) day and removal time for plaster cast (4.24±0.82) week.The follow-up period was (7.98±2.32) month.There were 5 complicated cases, including nail tail irritation (n=3), fracture displacement (n=1) and radial nerve injury (n=1).Delayed or nonunion fracture was absent.At the last follow-up, pronation angle of healthy forearm was (88.67±3.20)°, supination Angle of forearm (85.67±4.74)°, palmar flexion angle of wrist joint (62.22±8.76)°, dorsiflexion angle of wrist joint (67.15±7.42)°, ulnar tilt angle of wrist joint (31.40±4.23)° and radial tilt angle of wrist joint (21.26±3.06)°.Pronation angle of affected forearm was (84.76±4.86)°, supination angle of forearm (84.28±4.79)°, palmar flexion angle of wrist joint (62.67±8.83)°, dorsiflexion angle of wrist joint (66.65±7.38)°, ulnar tilt angle of wrist joint (31.69±3.85)° and radial tilt angle of wrist joint (20.89±2.57)°.No statistically significant difference existed between the two (P>0.05).At the last follow-up, the functional evaluation results of Anderson’s forearm fractures were excellent (n=44) and decent (n=2). Conclusions Anterograde elastic intramedullary nailing is efficacious for severely displaced unstable distal radial metaphyseal junction fractures in children.It offers the advantages of no epiphyseal damage, fewer postoperative complications and excellent functional recovery.
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备注/Memo
收稿日期:2022-11-6。
基金项目:安徽医科大学科学基金项目(2023xkj103)
通讯作者:林昱东，Email: ahpolinyudong@163.com