B型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折  

Ultrasound guided percutaneous Kirschner - wire leverage and reduction for radial neck fracture in children

作　　者：沈先涛[1] 陈小亮[1] 李雄涛[1] 伍兴[1] 李俊[1] 张平[1] 孙杰[2] 赵亚平[2] 

机构地区：[1]武汉市妇女儿童医疗保健中心、武汉市儿童医院骨科,430016 [2]武汉市妇女儿童医疗保健中心、武汉市儿童医院超声科,430016

出　　处：《中华小儿外科杂志》2015年第5期363-367,共5页Chinese Journal of Pediatric Surgery

基　　金：湖北省自然科学基金资助项目（2013cKB026）

摘　　要：目的探讨超声在儿童桡骨颈骨折的诊断及治疗的价值，为桡骨颈骨折的微创治疗提供一种有效、安全、可靠的方法。方法2012年8月至2014年5月，本院收治14例桡骨颈骨折患儿，其中O’BrienⅡ型10例，O’BrienⅢ型4例。均采用B型超声引导下经皮克氏针撬拨闭合复位，克氏针内固定石膏外固定。术后4～6周拆除石膏拔除克氏针开始功能锻炼。结果术后患儿均I期愈合。14例均获得随访，随访时间最短6个月，最长23个月，平均随访时间10．6个月。术后X线片按Metaizeau等的标准评定，优12例，良2例，优良率100％。末次随访时，肘关节屈、伸、旋前、旋后活动度、提携角按Steel和Gtrham评分标准，优良率（100％）。结论超声是一种无创检查技术，手术中通过超声引导，可以指导桡骨颈骨折的经皮克氏针撬拨，达到精确定位，具有微创、固定牢固、手术操作简便、允许术后早期活动、并发症少等优点。同时减少患儿及医务人员的x线暴露，具有良好的应用前景。Objective To explore the ultrasonic images of radial neck fracture in children and evaluate the value of ultrasound in its diagnosis and treatment so as to provide an effective, safe and reliable method for its mini - invasive treatment. Methods A total of 14 patients of radial neck fracture were recruited. The types were O＇Brien Ⅱ （n = 10） and Obrien Ⅲ （n = 4）. All patients underwent percutaneous Kirschner wire leverage （PKWL） guided by ultrasound, kirschner wire fixation and plaster external fixation. After 4-6 weeks later, functional exercise began after plaster removal and needle extraction. Results The average follow-up period was 10. 6 （6-23） months. According to the postoperative X-ray by Metaizeau＇s standard, the outcomes were excellent （n = 12） and fair （n = 2）. Based upon the Steel and Gtrham grading standard, elbow bending, stretching, pronation, supination activity and affirmative Angle were all excellent （100%） at the last follow-up. Conclusions As a noninvasive examination, ultrasound has great application prospects for percutaneous Kirschner wire leverage for accurate positioning in radial neck fracture. The advantages are mini-invasiveness, stable fixation, simple handling, early postoperative activity and fewer complications. Also it reduces the X-ray exposure of both children and medical staff.

关 键 词：桡骨颈骨折 超声检查 儿童 

分 类 号：R726.8[医药卫生—儿科]