两种方法治疗小儿前臂闭合骨折的疗效分析  

Two methods of treatment of pediatric forearm closed fractures: analysis of the treatment effect

作　　者：施建东[1] 卢一生[1] 黄波[1] 徐静芳[1] 刘振刚[1] 

机构地区：[1]解放军第117医院骨科,浙江杭州310000

出　　处：《临床骨科杂志》2015年第2期230-233,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较手法复位外固定与切开复位内固定小儿前臂闭合骨折的临床疗效。方法回顾分析216例小儿前臂闭合骨折患者的病例资料,其中167例通过手法复位外固定,49例行切开复位内固定。评估两种方法的治疗效果及并发症。结果所有患者均获随访,时间3~24个月。骨折愈合时间：手法复位外固定组为4~11（6.4±1.2）周,切开复位内固定组为6~15（8.5±1.9）周,差异有统计学意义（P〈0.05）。根据疼痛和旋转角度丧失评定疗效,手法复位外固定组优良率94.0%,切开复位内固定组优良率93.9%,两组优良率比较差异无统计学意义（P〉0.05）。手法复位外固定组中,133例≤10岁的患者中7例出现前臂旋转功能障碍,34例〉10岁的患者中有6例出现功能障碍;未出现骨筋膜间室综合征等并发症。切开复位内固定组中,38例〉10岁的患者中1例术后24h内出现骨筋膜间室综合征,1例出现骨折延迟愈合,11例≤10岁的患者中1例出现再骨折;未出现内固定术后感染等并发症。两组并发症比较差异有统计学意义（P〈0.05）。结论对于小儿前臂闭合骨折,因≤10岁的患者骨膜较厚,有较强的塑形能力,建议以手法复位石膏外固定治疗为主;而对于〉10岁或经手法复位石膏外固定不能维持骨折断端稳定的患者,可行手术内固定治疗。Objective To compare the manual reduction external fixation and open reduction internal fixation of the clinical outcome of pediatric forearm closed fracture. Methods 216 cases of patients with fracture of pediatric forearm closed information were retrospective analyzed,including 167 cases through reduction and external fixation,49 cases were undergone open reduction and internal fixation. The outcomes were evaluated by comparing the effect and complication of the two methods. Results All patients were followed up for 3 ~ 24 months. Fracture healing time：manual reduction external fixation group was 4 ~ 11（6. 4 ± 1. 2） weeks,and open reduction internal fixation group was 6 ~ 15（8. 5 ± 1. 9） weeks. There was significant difference between both groups（ P〈0. 05）. According to the pain and the rotation angle of loss evaluation,the excellent-good rate of manual reduction external fixation group was94. 0%,open reduction internal fixation group was 93. 9%. There was no significant difference for the excellent-good rate between both groups（ P〈0. 05）. In manual reduction external fixation group,7 cases of 133 cases（ ≤10years） got forearm rotation disfunctions,6 cases of 34 cases（ 10 years） got forearm rotation disfunctions. There were no other complications such as osteofacial compartment syndrome. In open reduction internal fixation group,1case of 38 cases（ 10 years） developed osteofacial compartment syndrome during 24 hours postoperation,and 1case got delayed union of fractures. 1 case of 11 cases（ ≤10 years） got re-fractures. There were no other complications such as postoperative infection in posterior internal fixation. There was significant difference for the complications between both groups（ P〈0. 05）. Conclusions Because of the thicker eardrum,for these patients older than10 years,with good remodeling capability,manual reduction external fixation are suggested. For these patients less than 10 years,or the fragment ends fail to maintain stability by manual reduction

关 键 词：小儿 尺骨骨折 桡骨骨折 骨折固定术 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]