Pan Bowen,Zhao Guoqiang,Zhu Ming,et al.Treatment of radial neck fracture in children by percutaneous K-wire pry plus intramedullary needle internal fixation under ultrasonic guidance[J].Journal of Clinical Pediatric Surgery,2022,21(02):174-178.[doi:10.3760/cma.j.cn.101785-202104073-014]
超声引导下经皮克氏针撬拨联合髓内针内固定治疗儿童桡骨颈骨折
- Title:
- Treatment of radial neck fracture in children by percutaneous K-wire pry plus intramedullary needle internal fixation under ultrasonic guidance
- Keywords:
- Radius Fractures/SU; Fracture Fixation; Internal; Closed Fracture Reduction; Ultrasonography; Treatment Outcome
- 摘要:
- 目的 探讨超声及髓内针在儿童桡骨颈骨折治疗中的意义，为临床治疗儿童桡骨颈骨折提供一种微创、无辐射的治疗方法。方法 回顾性分析2018年8月至2019年12月浙江大学医学院附属儿童医院收治的16例桡骨颈骨折患儿临床资料及影像学资料，包括手术时间，术中出血量、透视次数，术后骨折愈合时间、肘关节功能、有无神经损伤、或骨骺早闭等。结果 16例手术时间（26±3.7）min，术中出血量（2±1.5）mL，术中透视2~6次，术后骨折愈合时间（1.8±0.5）个月。均获得术后随访，随访时间6~18个月。术后3~8个月取出内固定，平均时间5.5个月，患儿均获得骨性愈合；参考Metaizeau评价标准，14例疗效为优，2例疗效为良，优良率100%。功能评定：15例为优，1例为良；优良率100%。无一例出现神经损伤、骨骺早闭；1例取出内固定后出现切口感染，门诊随访愈合良好。结论 超声引导下治疗儿童桡骨颈骨折安全可靠；联合应用弹性髓内针可以避免桡骨近端骨骺的损伤。
- Abstract:
- Objective To explore the significance of ultrasonography and intramedullary needle in the treatment of radial neck fractures and provide a mini-invasive and radiation-free treatment for radial neck fractures in children. Methods From August 2018 to December 2019, clinical data were reviewed for 16 children hospitalized with Juedet Ⅲ/Ⅳ radial neck fractures.There were 6 boys and 10 girls with an average age of 98(45-135) months.And the involved side was left (n=11) and right (n=5).Emergency manual reduction failed.There were Juedet Ⅲ (n=12) and Ⅳ (n=4).The former included ulna fracture (n=3).The average time between injury and operation was 2.1(0.5-5) days.After admission, needle under ultrasonography-guided reduction by percutaneous K-wire pry was followed by intramedullary needle internal fixation.Operative duration, intraoperative volume of blood loss, intraoperative fluoroscopic frequency and postoperative fracture healing time were recorded.Before removing internal fixation, Metaizeau technique was employed for evaluating elbow function.Such postoperative complications as presence of nerve damage and early epiphyseal closure were evaluated.Results The postoperative follow-up period was (6-18) months.Operative duration was (13±3.7) min, intraoperative volume of blood loss (2±1.5) ml, intraoperative fluoroscopy frequency (2-6), postoperative fracture healing time (1.8±0.5) months and internal fixation removed within an average of 5.5(3-8) months.All cases achieved postoperative osseous healing.Based upon the Metaizeau criteria, the outcome was excellent (n=14) and decent (n=2) with an excellent/decent rate of 100%; Functional recovery was excellent (n=15) and decent (n=1) with an excellent/decent rate of 100%.There was no postoperative occurrence of nerve injury or early epiphyseal closure.One case of incision infection occurred after removing internal fixation and healing was excellent during outpatient follow-ups.Conclusion Ultrasonography guided treatment of radial neck fracture is both safe and reliable in children.Through accurately prying fracture end during operation, it reduces iatrogenic injury caused by blind operation and minimize the radiation exposure of operator and patients.Using an elastic intramedullary needle may prevent metaphyseal injury of proximal radius.
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备注/Memo
收稿日期:2021-04-23。
基金项目:浙江省卫生厅医药科技项目（2017KY444）
通讯作者:赵国强,Email:hello868@zju.edu.cn