儿童及青少年西摩骨折的治疗  

SURGICAL TREATMENT OF Seymour FRACTURES IN CHILDREN AND ADOLESCENTS

作　　者：张磊[1] 左玉明[1] 王月光[1] 周宏艳[1] 王国强[1] 于铁强[1] 易凡[1] 李亮[1] 

机构地区：[1]唐山市第二医院小儿骨科,河北唐山063000

出　　处：《中国修复重建外科杂志》2016年第5期529-531,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨儿童及青少年西摩骨折的治疗方法及疗效。方法 回顾分析2013年1月-2015年11月收治的26例儿童及青少年西摩骨折患者临床资料。男18例,女8例;年龄1岁1个月~17岁,中位年龄8.2岁。致伤原因：挤压伤14例,重物砸伤10例,戳伤2例。损伤指别：拇指2例,示指1例,中指12例,环指6例,小指5例。受伤至手术时间1~15 h,平均3.2 h。入院后行清创、拔甲、甲基质修补、闭合复位克氏针固定、石膏固定治疗。术后4周去除克氏针及石膏固定,行手指功能锻炼。结果 术后切口均Ⅰ期愈合,无感染等早期并发症发生。26例均获随访,随访时间3~24个月,平均12.3个月。X线片复查示,骨折均愈合,愈合时间1~2个月,平均1.4个月;无骨折畸形愈合、骨折再移位骨骺早闭及甲板不能生长等并发症发生。1例术后出现甲板畸形,无需手术处理。末次随访时1例患者伤指远指间关节伸直受限约10°,屈曲正常;其余患者伤指远指间关节屈伸范围为0~75°与健侧0~78°相比无显著差异。结论 对于儿童及青少年西摩骨折,急诊行清创、拔甲、甲基质修补、闭合复位克氏针固定治疗可获满意疗效。Objective To discuss the treatment method and effectiveness of Seymour fracture in children and adolescents. Methods Between January 2013 and November 2015, 26 children and adolescents with Seymour fractures were treated. There were 18 males and 8 females, aged from 1 year and 1 month to 17 years （median, 8.2 years）. The injury causes included crush in 14 cases, bruise in 10 cases, and puncture in 2 cases. The thumb was involved in 2 cases, index finger in 1 case, middle finger in 12 cases, ring finger in 6 cases, and little finger in 5 cases. The time from injury to operation was 1-15 hours （mean, 3.2 hours）. The patients underwent debridement, nail removal, nail matrix repair, dosed reduction and osteosynthesis with Kirschner wires, and splinting in emergency. Kirschner wires and splints were removed at 4 weeks after surgery, and functional exercises were done. Results All wounds healed by first intention without infection. The follow-up duration was 2-24 months （mean, 12.3 months）. The fracture healing was obtained at 1-2 months （mean, 1.4 months） on X-ray film, and no complications of nonunion, malunion, re-displacement, premature epiphyseal closure, or no growth of the nails occurred. Nail deformity developed in 1 case and no re-operation was given. At last follow-up, 1 patient had 10° extension limitation of the distal interphalangeal joint, but the flexion was normal. The motion range of distal interphalangeal joint was 0-75°, showing no significant difference when compared with that of contralateral side （0- 78°）. Conclusion The effectiveness for treating Seymour fracture is satisfactory by debridement, nail removal, nail matrix repair, closed reduction and osteosynthesis with Kirschner wires, and splinting in emergency.

关 键 词：西摩骨折 内固定 甲基质 骨骺早闭 儿童 青少年 

分 类 号：R726.8[医药卫生—儿科]