目的 回顾性分析73例儿童桡骨颈骨折的疗效,探讨与预后相关的因素。 方法 收集2010年3月至2016年3月在我院治疗的73例儿童桡骨颈骨折病例资料,分析年龄、骨折类型、治疗方法、复位后X线检查情况等因素与预后的关系。 结果 年龄与预后相关,本组年龄≤10岁的儿童疗效优良率为87.3%,>10岁的儿童优良率为61.1%。骨折类型与疗效密切相关,95.0%的O'Brien Ⅰ型骨折疗效优良; O'Brien Ⅱ型和Ⅲ型骨折疗效优良率分别是87.0%和66.7%。根据骨折类型选择治疗方法,仅需石膏固定者优良率最高(96.2%),而需手术复位克氏针或弹性髓内钉固定者优良率只有72.3%; 手术患者中经皮闭合复位固定的有80%的优良率; 虽然术后影像学上评估切开复位骨折对位对线优于闭合复位,但优良率只有50%。 结论 儿童桡骨颈骨折的预后与年龄、骨折类型、处理方法等因素相关,小于10岁、骨折移位轻、需手术干预少者预后优良率高。建议根据不同骨折类型采取相应的处理方法,需要手术者尽量使用闭合复位、弹性钉内固定。
Objective To retrospectively explore the efficacies and prognostic factors of pediatric radial neck fractures. Methods A total of 73 cases of pediatric radial neck fractures were hospitalized at our hospital from March 2010 to March 2016. Various variables,such as age,type of fractures,treatments,radiological studies and other factors,were analyzed. Results Patients aged under 10 years fared better than those aged above 10 years. The excellent or good rate was 87.3% in patients aged under 10 years and 61.1% in those aged above 10 years. Fracture types were closely correlated with outcomes. And the excellent or good rates were 95.0%,87.0% and 66.7% for O'Brien types Ⅰ,Ⅱ and Ⅲ respectively. Treatment methods were also correlated with prognosis. Patients with direct plaster fixation achieved an excellent or good rate of 96.2% versus 72.3% for surgical Kirschner wire or flexible intramedullary nail fixation. Among 80% children undergoing percutaneous reduction,the excellent or good rate was obtained. Only 50% cases undergoing open reduction had excellent or good outcomes. Postoperative radiographic evaluations of open reduction fracture was better than those of closed reduction. Conclusion s The prognosis of pediatric radial neck fractures is correlated with age,fracture types,treatment methods and other factors. And children aged over 10 years,with severe fracture and undergoing open reduction have worse outcomes. Less invasive reduction should precede open reduction.
