闭合复位弹性髓内钉固定和经皮克氏针撬拨复位固定治疗儿童O’Brien Ⅱ、Ⅲ型桡骨颈骨折的疗效比较  

A clinical comparison of closed reduction and internal fixation with elastic intramedullary nails versus percutaneous leverage reduction and internal fixation with Kirschner wire for treatment of O'Brien type Ⅱ and Ⅲ radial neck fractures in children

作　　者：明晓锋[1] 陈登山[1] 张晓强[1] 

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院,河南郑州450016

出　　处：《中医正骨》2016年第2期15-19,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较闭合复位弹性髓内钉固定和经皮克氏针撬拨复位固定治疗儿童O’BrienⅡ、Ⅲ型桡骨颈骨折的临床疗效。方法:2010年5月至2014年10月收治218例O’BrienⅡ、Ⅲ型桡骨颈骨折患儿,102例采用闭合复位弹性髓内钉固定治疗(髓内钉组)、116例采用经皮克氏针撬拨复位固定治疗(克氏针组)。比较2组的手术时间、术中出血量、住院时间、总费用、骨折复位情况、骨折愈合时间及肘关节功能。结果:2组患者的术中出血量、住院时间、骨折愈合时间比较,组间差异均无统计学意义[(9.73±1.44)mL,(9.98±1.60)mL,t=-1.710,P=0.183;(6.64±1.03)d,(6.58±0.95)d,t=0.630,P=0.711;(42.45±3.53)d,(41.64±2.96)d,t=1.240,P=0.287];髓内钉组的手术时间和总费用均大于克氏针组[(33.34±2.48)min,(21.45±1.79)min,t=3.880,P=0.001;(10.05±0.61)万元,(5.23±0.65)万元,t=79.470,P=0.000]。术后采用Metaizeau复位标准评定骨折复位情况,髓内钉组优69例、良29例、可4例,克氏针组优74例、良37例、可5例;2组患者的骨折复位情况比较,差异无统计学意义(Z=-0.587,P=0.557);术后6个月采用改良Broberg和Morrey评分标准评定肘关节功能,髓内钉组优61例、良37例、可4例,克氏针组优57例、良47例、可12例;2组患者的肘关节功能比较,差异无统计学意义(Z=-1.845,P=0.065)。结论:采用闭合复位弹性髓内钉固定和经皮克氏针撬拨复位固定治疗儿童O’BrienⅡ、Ⅲ型桡骨颈骨折,创伤均较小,均能使骨折获得良好复位和固定,术后肘关节功能恢复较好,二者的疗效相当,但采用经皮克氏针撬拨复位固定治疗手术时间短、费用较低。Objective： To compare the curative effect of closed reduction and internal fixation with elastic intramedullary nails versus percutaneous leverage reduction and internal fixation with Kirschner wire for the treatment of O＇Brien typeⅡandⅢradial neck fractures in children. Methods： Two hundred and eighteen children with O＇Brien typeⅡorⅢradial neck fractures were recruited from May 2010 to October 2014. One hundred and two children were treated with closed reduction and internal fixation with elastic intramedullary nails（ intramedullary nails group）,and 116 children were treated with percutaneous leverage reduction and internal fixation with Kirschner wire（ Kirschner wire group）. The operative time,blood loss,hospital stay,total expense,fracture reduction,fracture healing time and elbow joint function were compared between the 2 groups. Results： There was no statistical difference in blood loss,hospital stay and fracture healing time between the two groups（ 9. 73 ＋ /- 1. 44 vs 9. 98 ＋ /- 1. 60 ml,t =- 1. 710,P = 0. 183; 6. 64 ＋ /- 1. 03 vs 6. 58 ＋ /- 0. 95 days,t = 0. 630,P = 0. 711; 42. 45 ＋ /- 3. 53 vs 41. 64 ＋ /- 2. 96 days,t = 1. 240,P = 0. 287）. The operative time and total expense of intramedullary nails group were greater than those of Kirschner wire group（ 33. 34 ＋ /- 2. 48 vs 21. 45 ＋ /- 1. 79 min,t = 3. 880,P = 0. 001; 100. 5 ＋ /- 6. 1 vs52. 3 ＋ /- 6. 5 thousands Yuan,t = 79. 470,P = 0. 000）. The fracture reduction were evaluated according to Metaizeau reduction standard after the surgery. Sixty- nine children obtained an excellent result,29 good and 4 fair in the intramedullary nails group; while 74 children obtained an excellent result,37 good and 5 fair in the Kirschner wire group. There was no statistical difference in fracture reduction between the two groups（ Z =- 0. 587,P = 0. 557）. The elbow joint function were evaluated according to improved Broberg- Morrey scoring standard at 6 months after surgery,Sixty- one children obtained an excellent

关 键 词：桡骨骨折 桡骨颈 儿童 外科手术 微创性 髓内钉 克氏针 治疗 临床研究性 

分 类 号：R726.8[医药卫生—儿科]