平乐正骨配合撬拨复位髓内针固定治疗儿童不稳定尺桡骨骨折临床观察  

The Clinical Observation of the Treatment of Pingle Bonesetting and Percutaneous Reduction by Leverage with Intramedullary Nailing Interfixaion on Unstable Fractures of Ulna and Radius in Children

作　　者：夏玉礼[1] 马长生[1] 苏驰[1] 徐广建 

机构地区：[1]广东省深圳平乐骨伤科医院,广东深圳518000

出　　处：《中国中医急症》2016年第1期130-132,共3页Journal of Emergency in Traditional Chinese Medicine

基　　金：广东省深圳市卫生计生系统科研项目(201506098)

摘　　要：目的观察平乐正骨手法配合经皮钢针撬拨复位髓内针内固定治疗儿童不稳定尺桡骨骨折的临床疗效。方法回顾性分析儿童不稳定尺桡骨骨折患者126例,均采用平乐正骨手法配合经皮钢针撬拨复位髓内针内固定治疗,其中男性83例,女性43例;年龄4~16岁,中位年龄10岁;尺桡骨上段骨折28例,中段骨折67例,下段骨折31例;闭合骨折91例,GustiloⅠ型开放骨折35例;合并桡神经损伤13例,正中神经损伤9例,尺神经损伤6例;伤后至手术时间1~21 d;在C型臂X线机透视下先行手法整复,在骨折端处经皮钢针撬拨复位,透视证实骨折端复位满意后经皮贯穿髓腔置入钢针或弹性髓内钉固定断端。钢针固定47例,弹性髓内钉固定79例;术后屈肘60~90°,前臂中立位石膏托外固定,3~4周去除外固定石膏托,进行肘关节、腕关节屈伸锻炼;术后4~6周进行前臂旋转锻炼;术后12周待骨折愈合取出内固定髓内针。结果本组病例均获得随访,随访时间6~24个月,中位数15个月。观察骨折愈合、患肢功能恢复情况、有无并发症。骨折均获愈合。肘关节、腕关节屈伸活动及前臂旋转活动功能均正常。11例钉尾处出现皮肤激惹症状,拔钉后症状消失。均无医源性神经损伤、骨折延迟愈合或畸形愈合、前臂缩短或旋转畸形等并发症发生。疗效评定为优105例、良16例、可5例。结论平乐正骨配合钢针撬拨复位髓内针内固定治疗儿童不稳定尺桡骨骨折临床效果肯定,创伤小,并发症少,可操作性强。Objective： To study the clinical effect and operability of the treatment of Pingle bonesetting and percutaneous reduction by leverage with intramedullary nailing interfixaion on unstable fractures of ulna and radius in children. Methods： 126 cases with unstable fractures of ulna and radius in children were retrospectively analyzed of male 83 cases,female 43 cases,aged from 4 years to 16 years old,median 10 years old： site of the ulna and radius frctures about proximal 28 cases,middle 67 cases,distal 31 cases,91 cases of closed fractures,35 cases of open fractures of Gustilo type Ⅰ,radial nerve in 13 cases,median nerve in 9 cases,ulnar nerve in 6 cases,the time from injury to clinical treatment from 1 to 21 days,middle 2.3 days. These fractures were treated with manipulative andpercutaneous reduction by leverage. C arm X-ray machine perspectively was used to determine fracture reduction,X-ray confirmed that the fractures were satisfied with the reduction,through the broken end of the medullary cavity fixed with percutaneous K-wire or elastic intramedullary nail,with K-wire fixation in 47 cases,elastic intramedullary nail fixation in 79 cases. Postoperatively elbow flexion 60~90 and forearm neutral posi-tion with plaster external fixation. 3~4 weeks later,external fixation was removed and functional exercise with elbow joint,wrist joint flexion and extension were taken. 4 ~6 weeks later,forearm rotation exercise was taken. 12 weeks later,the internal fixation of the intramedullary nails were removed. Results： All patients were followed up during 6 to 24 months,average 15 months. The function of elbow joint,wrist joint flexion and extension and forearm roationactivities were normal. The symptoms of skin irritation occurred in 11 cases,and the symptoms disappeared after pulling the nail. No iatrogenic injury,delayed union of fracture,or abnormal healing,shortening or rotation of the forearm or other complications occurred. According to Anderson forearm fracture treatment effect evaluation classification sta

关 键 词：儿童 闭合复位 尺桡骨干骨折 骨折内固定术 

分 类 号：R274.1[医药卫生—中医骨伤科学]