双针撬拨法联合弹性钉治疗儿童桡骨头JudetⅣ型骨折疗效分析  

Efficacy analysis of double needle prying method combined with elastic nail in the treatment of Judet typeⅣfracture of radial head in children

作　　者：张荐[1] 王斌[2] 王月光[1] 周宏艳[1] 杨焕友[2] ZHANG Jian;WANG Bin;WANG Yue-guang;ZHOU Hong-yan;YANG Huan-you(Department of Pediatric Orthopedics 2,The Second Hospital of Tangshan,Tangshan,Hebei,063000,China)

机构地区：[1]唐山市第二医院小儿骨2科,河北省063000 [2]唐山市第二医院手1科、修复重建外科,河北省063000

出　　处：《中国骨与关节杂志》2023年第11期801-805,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨双针撬拨法联合弹性钉治疗儿童桡骨头JudetⅣ型骨折临床疗效。方法回顾分析2017年3月至2021年6月,我院收治的45例桡骨头JudetⅣ型骨折患儿的资料。其中男23例,女22例;年龄6~11岁,平均7.6岁。试验组24例,行双针撬拨法联合弹性钉固定术;对照组21例,行单针撬拨法联合弹性钉固定术,术后两组均行长臂石膏托固定4周。术后比较两组的手术时间、骨折复位和神经损伤情况以及肘关节功能。结果45例均获随访,随访时间10~20个月,平均13个月。手术时间:试验组(25.21±4.82)min,对照组(36.71±6.83)min,差异有统计学意义(P<0.05)。骨折复位情况以Metaizeau标准行放射学评定,试验组24例均解剖复位;对照组优14例(解剖复位),良6例(成角≤20°),中0例(成角30°~35°),差1例(水平移位约2 mm),差异有统计学意义(P<0.05)。肘关节功能评定参照中华医学会手外科学会上肢功能评定标准,试验组优23例,良1例;对照组优14例,良6例,差1例,差异有统计学意义(P<0.05)。结论双针撬拨法联合弹性钉固定具有耗时少、骨折复位佳及肘关节功能恢复好的优势,是治疗儿童桡骨头JudetⅣ型骨折的有效方法。Objective To investigate the clinical effect of double needle prying combined with elastic nail in the treatment of Judet type IV fracture of radial head in children.Methods From March 2017 to June 2021,45 children with radial head fracture(JudetⅣ)were admitted to our hospital.There were 23 males and 22 females.The age range was 6-11 years with a mean of 7.6 years.Experimental group:24 cases of double needle prying combined with elastic nail fixation;Control group:21 cases were fixed by single needle prying combined with elastic nail;both groups were fixed with long-arm plaster for 4 weeks after surgery.Analysis of short-term results:operation time,fracture reduction and nerve injury;Long-term follow-up:elbow joint function evaluation.Results All 45 cases were followed up for 10-20 months,with an average of 13 months.Operation time:experimental group(25.21±4.82)min,control group(36.71±6.83)min,the differences were statistically significant(P<0.05).Fracture reduction was evaluated by radiology according to Metaizeau criteria.In the experimental group,24 cases achieved anatomic reduction.Control group:Excellent in 14 cases(anatomical reduction),good in 6 cases(angle formation≤20°),fair in 0 case(angle formation 30°-35°),poor in 1 case(horizontal displacement about 2 mm);the differences were statistically significant(P<0.05).Elbow joint function was evaluated according to the standard of upper limb function evaluation of the Hand Surgery Society of the Chinese Medical Association.In the experimental group,23 cases were excellent and 1 case was good.Control group:excellent in 14 cases,good in 6 cases,poor in 1 case,the differences were statistically significant(P<0.05).Conclusions The optimal pry-pull structure combined with elastic nail fixation has the advantages of less time,better fracture reduction and better elbow joint function recovery.It is an effective method for the treatment of Judet type IV fracture of radial head in children.

关 键 词：儿童 桡骨骨折 骨钉 骨折固定术 

分 类 号：R683.4[医药卫生—骨科学]