超声引导闭合复位经皮内固定治疗儿童桡骨远端骨骺骨折  

Ultrasound-guided close reduction and percutaneous pinning for pediatric distal radial physeal fractures

作　　者：伍兴[1] 夏敬冬[1] 李雄涛[1] 陈小亮[1] 王思 张平[1] 沈先涛[1] Wu Xing;Xia Jingdong;Li Xiongtao;Chen Xiaoliang;Wang Si;Zhang Ping;Shen Xiantao(Department of Pediatric Orthopedic Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院骨科,430016

出　　处：《中华小儿外科杂志》2020年第11期1005-1009,共5页Chinese Journal of Pediatric Surgery

基　　金：武汉市卫生计生委科研项目(WX14C49);湖北省自然科学基金(2013CKB026)。

摘　　要：目的探讨超声引导下闭合复位经皮内固定治疗儿童桡骨远端骨骺骨折的可行性和安全性。方法回顾性分析武汉儿童医院骨科2014年3月至2017年6月收治的58例行超声引导下闭合复位经皮内固定治疗的儿童桡骨远端骨骺骨折患儿的临床资料。其中,男48例,女10例;年龄(11.2±2.3)岁,范围在5.8~16.9岁。所有患儿术中采用3个标准切面(掌侧、背侧、冠状外侧)的超声图像辅助骨折复位。术后采用改良Mayo腕关节评分标准(MMWS)和影像学检查进行评估疗效。结果所有桡骨远端骨骺骨折患儿骨折术后X线检查结果均显示获得解剖复位。58例患儿手术时间12~36 min,平均19.3 min;术中透视次数2~4次,平均2.3次。所有患儿均获随访,时间为13~28个月,平均21.9个月。所有患儿骨折均愈合,未发生骨折再移位。末次随访时,患儿MMWS评分为85~100分,平均97.6分。其中,优56例,良2例。随访过程中,有4例患儿发生浅表针道感染,其中3例常规伤口换药恢复,1例拔除克氏针后自行好转,所有患儿均未使用抗生素治疗。1例患儿在术后2年发生同侧桡骨远端再骨折。4例患儿桡骨短缩2.0~4.5 mm,平均短缩3.2 mm。术后未出现如缺血性坏死或者畸形愈合等严重并发症。结论超声检查可用于辅助桡骨远端骨骺骨折复位。超声引导闭合复位经皮内固定对于儿童桡骨远端骨骺骨折,是一种安全有效的治疗方法。Objective To explore the feasibility and safety of ultrasound-guided close reduction and percutaneous pinning for pediatric distal radial physeal fractures.Methods From March 2014 to June 2017,clinical data were retrospectively reviewed for 58 cases of distal radial physeal fractures.Ultrasound-guided reduction and percutaneous fixation with Kirschner wire were performed.There were 48 boys and 10 girls with an average age of(11.2±2.3)(5.8-16.9)years.Ultrasound was employed primarily for monitoring the reduction of fractures through three standardized sectional planes of ventral,dorsal and transversal lateral.Clinical outcomes were evaluated postoperatively by the MMWS criteria and radiographic examinations.Results Anatomical reduction on radiography was achieved in all cases.The mean operative duration was 19.3(12-36)min,the mean number of intraoperative images 2.3(2-4)and the mean follow-up period 21.9(13-28)months.All fractures were healed and no re-displacement of fracture occurred in cast.At the last follow-up,the mean score of MMWS was 97.6(85-100)points.The outcomes were excellent(n=56)and decent(n=2).Complications included superficial pin tract infection(n=4),routine wound dressing change(n=3)and spontaneous improvement after removal of Kirschner wire(n=1).None of them received antibiotics.One child developed ipsilateral distal radius fracture at 2 years post-operation.The mean shortening of radius was 3.2(2.0-4.5)mm(n=4).There was no occurrence of such serious complications as ischemic necrosis or malunion.Conclusions Ultrasound may be employed for assessing the reduction outcomes of distal radius epiphyseal fracture.And ultrasound-guided reduction and percutaneous fixation are both safe and reliable for managing pediatric distal radial physeal fractures.

关 键 词：儿童 桡骨远端骨折 骨骺 闭合复位术 超声检查 

分 类 号：R726.8[医药卫生—儿科]