有限切开复位克氏针穿骺髓内固定大龄儿童难复性桡骨远端骨干-干骺端交界性骨折的疗效分析  

Limited open reduction and transepiphyseal intramedullary Kirschner wiring for irreducible fracture of the distal radius diaphysis-epiphysis junction in older children

作　　者：吴利伟 王儒法 Wu Liwei;Wang Rufa(Department of Infectious Diseases,Children's Hospital of Nanjing Medical University,Nanjing 210000,China;Department of Orthopedics,Children's Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院感染科,南京210000 [2]南京医科大学附属儿童医院骨科,南京210000

出　　处：《中华创伤骨科杂志》2024年第5期416-420,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨有限切开复位克氏针穿骺髓内固定治疗大龄儿童难复性桡骨远端骨干-干骺端交界性骨折的可行性及疗效。方法回顾性分析2018年1月至2019年12月南京医科大学附属儿童医院骨科收治的17例难复性桡骨远端骨干-干骺端交界性骨折患儿资料。均为男性;左侧10例,右侧7例;致伤原因均为间接暴力摔伤;受伤至手术时间(3.1±0.8)d。以骨折端为中心有限切开2~4 cm,采用1枚克氏针穿骺髓内固定。记录术后影像学结果、切口、前臂软组织情况及并发症发生情况。术后24个月采用Price等提出的分级系统评估前臂功能。结果17例患儿术后获(25.8±2.3)个月随访。所有患者手术时间为25(20,50)min。切口长度为(2.4±0.6)cm。术后桡骨成角畸形0°(0°,0°),术后桡骨移位(1.5±1.1)mm。术后2周切口愈合良好,无血管、神经并发症。1例出现针尾皮肤激惹。骨折愈合时间5.0(4.0,5.5)周。术后24个月Price等分级系统评估前臂功能:优15例,良2例。结论有限切开复位克氏针穿骺髓内固定治疗大龄儿童难复性桡骨远端骨干-干骺端交界性骨折,疗效确切,是一种值得推荐的术式。Objective To investigate the feasibility and clinical efficacy of limited open reduction and transepiphyseal intramedullary kirschner wiring for treatment of irreducible fracture of the distal radius diaphysis-epiphysis junction in older children.Methods A retrospective study was conducted to analyze the data of 17 children with fracture of the distal radius diaphysis-epiphysis junction who had been admitted to Department of Orthopedics,Children's Hospital of Nanjing Medical University from January 2018 to December 2019.All were male.Ten fractures were on the left side and 7 on the right side,all caused by indirect violent falls.The time from injury to operation was(3.1±0.8)d.After a limited incision,about 2 to 4 cm in length,was made with the fracture ends as the center,a single Kirschner wire was used for transepiphyseal and intramedullary fixation.Postoperative imaging results,incisions,forearm soft tissue,and complications were recorded.The forearm function was evaluated at 24 months after operation by the grading system proposed by Price et al.Results All the 17 patients were followed up for(25.8±2.3)months.In all patients,operation time was 25(20,50)min,incision length(2.4±0.6)cm,postoperative angular deformity of the radius 0°(0°,0°),and postoperative displacement of the radius(1.5±1.1)mm.Incisions healed well 2 weeks after operation with no vascular or neurological complications.Skin irritation of Kirschner wire appeared in 1 case.Fractures healed after 5.0(4.0,5.5)weeks.The forearm function evaluated by the Price grading at 24 months after operation was excellent in 15 cases and good in 2 cases.Conclusion Limited open reduction and transepiphyseal intramedullary kirschner wiring is effective for treatment of irreducible fracture of the distal radius diaphysis-epiphysis junction in older children.

关 键 词：儿童 骨折固定术 髓内 桡骨骨折 前臂功能 

分 类 号：R726.8[医药卫生—儿科]