Shi Jianing,Zhang Lin,Zhou Xianjun,et al.A comparative study of anterograde elastic intramedullary needling versus Kirschmann wiring for radial trunk and metaphyseal junction fractures in children[J].Journal of Clinical Pediatric Surgery,2023,22(09):866-870.[doi:10.3760/cma.j.cn101785-202207058-013]
顺行弹性髓内针与克氏针治疗儿童桡骨干与干骺端交界区骨折的对比研究
- Title:
- A comparative study of anterograde elastic intramedullary needling versus Kirschmann wiring for radial trunk and metaphyseal junction fractures in children
- Keywords:
- Fracture Fixation; Intramedullary; Radius Fractures; Surgical Procedures; Operative; Child
- 摘要:
- 目的 对比顺行弹性髓内针与传统克氏针治疗儿童桡骨干与干骺端交界区骨折的临床疗效。方法 回顾性分析青岛大学医学院附属医院自2019年1月至2022年1月收治的50例桡骨远端骨干与干骺端交界区骨折患儿临床资料,根据手术方式的不同分为顺行弹性髓内针组(17例)及克氏针组(33例)。临床资料包括性别、年龄、是否合并尺骨远端骨折、手术时间、术后2周骨折成角、对位情况。随访资料包括外固定时间、术后3个月腕关节活动度、腕关节功能优良率、肘关节功能优良率及并发症。结果 顺行弹性髓内针组手术时间长于克氏针组[(81.8±38.4)min比(59.4±26.1)min],差异无统计学意义(P>0.05);术后2周骨折平均对位率大于克氏针组(92%比88%),差异无统计学意义(P>0.05);拆除石膏外固定时间短于克氏针组[(31.5±5.1)d比(39.0±9.2)d],差异有统计学意义(P<0.05);术后3个月腕关节活动度指标高于克氏针组,差异有统计学意义(P<0.05);术后3个月腕关节恢复优良率高于克氏针组(94.12%比66.67%),差异有统计学意义(P<0.05);术后3个月肘关节恢复优良率低于克氏针组(82.35%比87.88%),差异无统计学意义(P>0.05)。结论 儿童桡骨远端骨干与干骺端交界区骨折采用顺行弹性髓内针治疗较传统克氏针治疗的临床效果好,可有效缩短术后拆除石膏外固定时间,有利于术后腕关节活动恢复,是治疗儿童桡骨远端骨干与干骺端交界区骨折的一种可选手术方法,具有临床推广价值。
- Abstract:
- Objective To compare the clinical efficacy and application value of a novel operative approach of anterograde elastic intramedullary needling versus traditional Kirschmann wiring for junction fractures of radius trunk and metaphyseal in children.Methods Retrospective analysis was performed for 50 children with fractures at junction of distal radial diaphysis and metaphysis from January 2019 to January 2022.They were assigned into two groups of anterograde elastic intramedullary acupuncture (n=17) and Kirschmann acupuncture (n=33) according to different surgical approaches.The relevant clinical data included gender,age,concurrent distal ulnar fracture,operative duration,fracture angulation and alignment status at Week 2 post-operation.Duration of external fixation,wrist motion,good/excellent rate of wrist function,good/excellent rate of elbow function and complications were recorded at Month 3 post-operation.Results Operative duration was longer in anterograde elastic intramedullary acupuncture group than that in Kirschner’s needle group[(81.8±38.4) vs.(59.4±26.1) min]and the difference was not statistically significant (P>0.05).The mean contraction of fractures was higher in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner’s needle group (92% vs.88%) and the difference was not statistically significant (P>0.05).The removal time of external plaster fixation was shorter in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture Kirschner’s needle group[(31.5±5.1) vs.(39.0±9.2) day]and the difference was statistically significant (P<0.05).The wrist range of motion was higher in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner’s needle anterograde elastic intramedullary acupuncture groupt Month 3 post-operation and the difference was statistically significant (P<0.05).The recovery rate of wrist joint was higher in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner’s needle group (94.12% vs.66.67%) and the difference was statistically significant (P<0.05).The good/excellent recovery rate of elbow joint was lower in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner’s needle group (82.35% vs.87.88%) and the difference was not statistically significant (P>0.05).Conclusion Compared with traditional Kirscher wiring,anterograde elastic intramedullary needling can effectively shorten the time of postoperative removal of plaster external fixation and facilitate the postoperative recovery of wrist joint activity.It is ideal for children with distal radial diaphyseal junction fractures and worth wider clinical promotions.
参考文献/References:
[1] Cheng JC,Ng BK,Ying SY,et al.A 10-year study of the changes in the pattern and treatment of 6,493 fractures[J].J Pediatr Orthop,1999,19(3):344-350.
[2] Bae DS.Pediatric distal radius and forearm fractures[J].J Hand Surg Am,2008,33(10):1911-1923.DOI:10.1016/j.jhsa.2008.10.013.
[3] 杜智军,陆士姣,张友波.弹性髓内针顺行固定治疗儿童桡骨远端干骺端移行部骨折[J].中国矫形外科杂志,2017,25(24):2290-2293.DOI:10.3977/j.issn.1005-8478.2017.24.19. Du ZJ,Lu SJ,Zhang YB.Elastic intramedullary needling for anterograde fixation of distal radius metaphyseal transition fractures in children[J].Orthop J China,2017,25(24):2290-2293.DOI:10.3977/j.issn.1005-8478.2017.24.19.
[4] Bae DS,Waters PM.Pediatric distal radius fractures and triangular fibrocartilage complex injuries[J].Hand Clin,2006,22(1):43-53.DOI:10.1016/j.hcl.2005.09.002.
[5] Slongo T,Audigé L,Lutz N,et al.Documentation of fracture severity with the AO classification of pediatric long-bone fractures[J].Acta Orthop,2007,78(2):247-253.DOI:10.1080/17453670710013753.
[6] 徐蕴岚,沈恺颖,王志刚.弹性髓内钉在儿童长骨干骺交界区骨折中的治疗体会[J].中国矫形外科杂志,2016,24(16):1455-1461.DOI:10.3977/j.issn.1005-8478.2016.16.04. Xu YL,Shen KY,Wang ZG.Elastic stable intramedullary nailing for fracture locating at borderline between diaphysis and metaphysis of long bone in children[J].Orthop J China,2016,24(16):1455-1461.DOI:10.3977/j.issn.1005-8478.2016.16.04.
[7] 杜蒙蒙.顺行弹性髓内钉治疗儿童桡骨远端骨干与干骺端交界区骨折:一种新的手术入路[D].石家庄:河北医科大学,2019. Du MM.Antegrade elastic stable intramedullary nail fixation for pediatric distal radial diaphyseal metaphyseal junction fractures:a novel operative approach[D].Shijiazhuang:Hebei Medical University,2019.
[8] Lieber J,Schmid E,Schmittenbecher PP.Unstable diametaphyseal forearm fractures:transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children[J].Eur J Pediatr Surg,2010,20(6):395-398.DOI:10.1055/s-0030-1262843.
[9] Yung PSH,Lam CY,Ng BKW,et al.Percutaneous transphyseal intramedullary Kirschner wire pinning:a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children[J].J Pediatr Orthop,2004,24(1):7-12.DOI:10.1097/00004694-200401000-00002.
[10] Miller BS,Taylor B,Widmann RF,et al.Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children:a prospective,randomized study[J].J Pediatr Orthop,2005,25(4):490-494.DOI:10.1097/01.bpo.0000158780.52849.39.
[11] 呼和,蒋飞,侯利民,等.两种手术方法治疗儿童桡骨远段1/3处骨折[J].临床骨科杂志,2020,23(3):384-386.DOI:10.3969/j.issn.1008-0287.2020.03.029. Hu H,Jiang F,Hou LM,et al.Two surgical approaches for distal 1/3 humeral fracture in children[J].J Clin Orthop,2020,23(3):384-386.DOI:10.3969/j.issn.1008-0287.2020.03.029.
[12] Lieber J,Joeris A,Knorr P,et al.ESIN in forearm fractures:clear indications,often used,but some avoidable complications[J].Eur J Trauma,2005,31(1):3-11.DOI:10.1007/s00068-005-1071-7.
相似文献/References:
[1]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(09):0.
[2]孙燕,廖怀章,孙炜,等.经桡骨Lister结节髓内固定治疗儿童尺桡骨干骨折40例[J].临床小儿外科杂志,2008,7(02):26.
[3]王强,宋宝健.髋人字支具固定治疗婴幼儿股骨骨折23例[J].临床小儿外科杂志,2008,7(05):1.
[4]丁波,彭立君.肱骨髁上骨折增加外固定时间的疗效观察[J].临床小儿外科杂志,2007,6(04):35.
[5]杜智军 吕洪海 王彭. 弹性髓内针固定治疗青少年锁骨中段骨折[J].临床小儿外科杂志,2012,11(01):4.
[6]吕洪海 陈蔚 王彭 杜智军. 弹性髓内针与交叉克氏针治疗儿童肱骨髁上[J].临床小儿外科杂志,2012,11(03):183.
[J].Journal of Clinical Pediatric Surgery,2012,11(09):183.
[7]易新成 鲍琨 陈博昌. 空心钉克氏针内固定治疗儿童陈旧性肱骨外髁骨折近期疗效观察[J].临床小儿外科杂志,2014,13(03):180.
[8]吴海艺,梁龙芳,裴新红.弹性髓内钉单骨固定治疗儿童前臂双骨折的疗效Meta分析[J].临床小儿外科杂志,2019,18(11):941.[doi:10.3969/j.issn.1671—6353.2019.11.009]
Wu Haiyi,Liang Longfang,Pei Xinhong.The effect of elastic stable intramedullary nailing single bone fixation in pediatric both bone forearm fractures: A Meta-analysis[J].Journal of Clinical Pediatric Surgery,2019,18(09):941.[doi:10.3969/j.issn.1671—6353.2019.11.009]
[9]孙燕,郭兴奇,陈志峰,等.“十”字缝合固定法治疗青少年急性髌骨脱位伴软骨面骨折的临床疗效[J].临床小儿外科杂志,2019,18(12):1031.[doi:10.3969/j.issn.1671-6353.2019.12.009]
Sun Yan,Guo Xingqi,Chen Zhifeng,et al.Clinical efficacy of “+” suturing fixation for acute patella dislocation with cartilage fracture in adolescents[J].Journal of Clinical Pediatric Surgery,2019,18(09):1031.[doi:10.3969/j.issn.1671-6353.2019.12.009]
[10]卢育南,林然,潘源城,等.闭合复位克氏针空心钉内固定治疗青少年肱骨髁间T型骨折的疗效分析[J].临床小儿外科杂志,2020,19(06):508.[doi:10.3969/j.issn.1671-6353.2020.06.009]
Lu Yunan,Lin Ran,Pan Yuancheng,et al.Treatment of T-type intercondylar humeral fractures with closed reduction K-wire and cannulated screw internal fixation[J].Journal of Clinical Pediatric Surgery,2020,19(09):508.[doi:10.3969/j.issn.1671-6353.2020.06.009]
[11]刘朝宇,张建强,徐文强,等.侧卧位斯氏针摇杆技术辅助复位髓内钉固定治疗青少年股骨骨折[J].临床小儿外科杂志,2024,(02):162.[doi:10.3760/cma.j.cn101785-202305033-012]
Liu Chaoyu,Zhang Jianqiang,Xu Wenqiang,et al.Efficacy analysis of intramedullary nail fixation for femoral shaft fractures in adolescents via a lateral recumbent position with Steinmann pin[J].Journal of Clinical Pediatric Surgery,2024,(09):162.[doi:10.3760/cma.j.cn101785-202305033-012]
备注/Memo
收稿日期:2022-7-30。
通讯作者:李富江,Email:lifujiang_88@163.com