超声联合关节造影辅助治疗儿童桡骨远端Salter-Harris Ⅲ型骨骺骨折的中短期疗效  

Short/middle-term clinical outcomes of ultrasound plus arthrography in the treatment of Salter Harris typeⅢepiphyseal fractures of distal radius in children

作　　者：马海龙 李阳[1] 袁悦 刘永 褚祥军 管之也 孙军[1] Ma Hailong;Li Yang;Yuan Yue;Liu Yong;Chu Xiangjun;Guan Zhiye;Sun Jun(Department of Orthopedics,Fifth Clinical Medical College,Anhui Medical University,Children's Medical Center,Anhui Provincial Children's Hospital,Hefei 230051,China)

机构地区：[1]安徽医科大学第五临床医学院,安徽医科大学儿童医学中心,安徽省儿童医院骨科,合肥230051

出　　处：《中华小儿外科杂志》2024年第2期138-142,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(U19A2057);安徽医科大学校科学研究基金资助项目(2020xkj254)。

摘　　要：目的探讨超声联合关节造影闭合复位经皮克氏针内固定治疗儿童桡骨远端Salter-Harris Ⅲ型骨骺骨折的中短期临床疗效。方法收集2017年4月至2022年4月安徽省儿童医院收治的行超声联合关节造影闭合复位经皮克氏针内固定治疗的桡骨远端Salter-Harris Ⅲ型骨骺骨折14例患儿的临床资料,其中男12例,女2例;平均年龄为10.2岁,年龄范围为7~14岁。所有患儿术中采用超声辅助骨折复位,再利用腕关节造影,观察关节面复位情况,验证骨折复位效果。记录手术时间、术中透视次数、骨折愈合时间及并发症(感染、针尾激惹等)。末次随访腕关节功能采用改良Mayo评分标准和影像学检查进行疗效评估。结果平均随访时间为12.4个月(2~24个月),平均手术时间为20.6 min;平均术中透视次数为5.2次。所有患儿骨折均愈合,平均愈合时间为4.4周。随访过程中,有2例患儿发生针尾激惹,拔除克氏针后自行好转。所有患儿术后X线检查结果均获解剖复位。末次随访时腕关节Mayo评分为80~100分,平均为92.6分。其中,优10例,良4例。结论超声联合关节造影在闭合复位经皮克氏针内固定治疗儿童桡骨远端Salter-Harris Ⅲ型骨骺骨折中具有微创、安全的治疗效果,值得推广应用。Objective To explore the short/middle-term clinical efficacies of ultrasound plus arthrography for closed reduction and internal fixation of percutaneous Kirschner wiring for Salter Harris typeⅢepiphyseal fractures of distal radius in children.Methods From April 2017 to April 2022,the relevant clinical data were retrospectively reviewed for 14 children with Salter Harris type III epiphyseal fracture of distal radius undergoing ultrasound plus arthrography,closed reduction and internal fixation of percutaneous Kirschner wiring.There were 12 boys and 2 girls with an average age of 10.2(7-14)years.After ultrasound assisted fracture reduction,wrist arthrography was employed for observing the reduction of articular surface and verifying the outcomes of fracture reduction.Operative durations and intraoperative fluoroscopic frequency were recorded.Time of fracture healing and complications(infection&needle tail irritation)were recorded.At the last follow-up,wrist function was evaluated by modified Mayo score and imaging studies.Results The average follow-up period was 12.4(2-24)months,the average operative duration 20.6 min and the average number of intraoperative fluoroscopy 5.2.All fractures healed with an average healing period of 4.4 weeks.Two cases of needle tail irritation improved after removing Kirschner wire.All of them were anatomically reduced on radiography.At the last follow-up,average Mayo score of wrist joint was 92.6(80-100).The outcomes were excellent(n=10)and decent(n=4).Conclusion Ultrasound plus arthrography is both mini-invasive and efficacious for Salter Harris typeⅢepiphyseal fracture of distal radius in children after closed reduction and percutaneous Kirschner wiring.It is worthy of a wider popularization.

关 键 词：骨骺 超声检查 关节造影术 桡骨远端骨折 儿童 

分 类 号：R726.8[医药卫生—儿科]