弹性髓内针与克氏针固定治疗儿童桡骨颈骨折的病例对照研究  

Management of displaced radial neck fractures in children:elastic stable intramedullary nailing vs K-wire fixation

作　　者：吴泉州[1] 黄淑明[1] 蔡奇勋[2] 褚旭峰[1] 

机构地区：[1]浙江大学丽水医院丽水市中心医院小儿骨科,浙江丽水323000 [2]上海交通大学附属新华医院儿童骨科,上海200092

出　　处：《中国骨伤》2017年第1期19-24,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较采用弹性髓内针与克氏针两种不同固定方式治疗桡骨颈骨折的临床疗效。方法:回顾性分析2009年1月至2014年12月,连续收治采取弹性髓内针(titanium elastic nail,TEN)固定与克氏针(K-wire,KW)固定的56例桡骨颈骨折患者。根据内固定方式的不同,将患者分为两组:TEN组25例,男15例,女10例;左侧11例,右侧14例;年龄(8.6±2.1)岁;骨折按Metaizeau-Judet改良分型:Ⅲ型16例,Ⅳ型9例;闭合复位20例,切开复位5例;受伤至手术时间1~8 d,平均(3.6±1.7)d。KW组31例,男20例,女11例;左侧12例,右侧19例;年龄(9.1±1.9)岁;骨折按Metaizeau-Judet改良分型,Ⅲ型19例,Ⅳ型12例;闭合复位22例,切开复位9例;受伤至手术时间2~7 d,平均(3.7±1.5)d。分别对两组患儿手术时间、住院时间、内固定取出时间、骨折愈合时间、术后并发症及临床疗效进行比较分析。结果:所有病例获得术后随访,TEN组随访时间16~48个月,平均22.1个月;KW组随访时间13~48个月,平均21.9个月。两组随访时间、骨折愈合时间及住院时间差异无统计学意义(P>0.05),但手术时间TEN组(56.6±11.8)min,长于KW组(45.5±10.3)min;内固定取出时间TEN组(9.1±2.5)周,长于KW组的(4.8±1.6)周;住院费用TEN组(1.8±0.3)万元,高于KW组(0.8±0.1)万元。按照Metaizeau等术后X线片评价及Tibone和Stoltz功能疗效评价标准,两组差异无统计学意义(P>0.05)。结论:弹性髓内针与克氏针两种固定方式治疗儿童Metaizeau-Judet改良Ⅲ、Ⅳ型桡骨颈骨折总体临床疗效相当,由于弹性髓内针治疗需住院麻醉下二次取出内固定,医疗费用明显大于克氏针,弹性髓内针尚不能替代传统的克式针固定治疗儿童桡骨颈骨折。Objective：To compare the complications and clinical outcome of titanium elastic nail （TEN） versus K-wire fixation （KW） for the treatment of displaced radial neck fractures in children. Methods：From January 2009 to December 2014,56 children with displaced radial neck fractures were studied retrospectively according to the inclusion criteria. Based on the different methods of internal fixation ,patients were divided into two groups ：titanium elastic nail （TEN group） and K-wire fixation （KW group）. Among 25 patients （15 males and 11 females,aged from 3 to 12 years old with an average of 8.6±2.1） treated with TEN, 16 patients had type Ⅲ fractures, 19 patients had type Ⅳ fractures according to Metaizeau-Judet modified classification; 20 patients were treated with closed reduction and 5 patients were treated with open reduction; the time from injury to treatment ranged from 1 to 8 days with an average of （3.6±1.7） days. Among 31 patients （20 males and 11 females, aged from 3 to 11 years old with an average of 9.1 ± 1.9 years old） treated with KW, 19 patients had type Ⅲ fractures, 12 pa- tients had type IV fractures;22 patients were treated with closed reduction, and 9 patients were treated with open reduction; the time from injury to treatment ranged from 2 to 7 days with an average of （3.7± 1.5） days. No significant differences between two groups were found in general data. Operative time, hospitalization time, healing time of fracture, internal fixation time, postoperative complications and function recovery of the two groups were compared and evaluated. Results.The average follow- up period of the patients was 22.1 months in TEN group （ranged, 16 to 48 months） ,and 21.9 months in KW group（ranged, 13 to 48 months）. There were no significant differences between these 2 groups in follow-up duration, average hospitalization time and fracture healing time. The operation time, hospital costs and internal fixation time in TEN group were （56.6±11.8） min, （18 000

关 键 词：骨折固定术 内 桡骨骨折 儿童 病例对照研究 

分 类 号：R726.834.1[医药卫生—儿科]