关节造影辅助下经皮弹性髓内钉治疗儿童桡骨颈骨折的疗效观察  

Clinical effects of percutaneous elastic intramedullary nail assisted by arthrography for the treatment of radial neck fractures in children

作　　者：周慧敏 许益文 陶春杰 范江荣 游景扬 阮家诚 沈思齐 王震 郑勇 ZHOU Hui-min;XU Yi-wen;TAO Chun-jie;FAN Jiang-rong;YOU Jing-yang;RUAN Jia-cheng;SHEN Si-qi;WANG Zhen;ZHENG Yong(Department of Orthopaedics,Xianning Central Hospital,Xianning437000,Hubei,China)

机构地区：[1]咸宁市中心医院骨科,湖北咸宁437000

出　　处：《中国骨伤》2024年第9期899-904,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨在关节造影辅助下闭合复位经皮弹性髓内钉治疗儿童桡骨颈骨折的临床疗效。方法:回顾性分析2019年1月至2022年12月关节造影辅助下闭合复位经皮弹性髓内钉内固定术治疗的23例桡骨颈骨折患儿(关节造影结合弹性钉组)的临床资料,男12例,女11例;年龄2~12(7.36±1.89)岁;根据Judet骨折分型,Ⅲ型14例,Ⅳ型9例。另选取2015年1月至2018年12月采用闭合复位经皮弹性髓内钉内固定术治疗的23例儿童桡骨颈骨折患儿(弹性钉组)的临床资料,其中男11例,女12例;年龄2~14(7.50±1.91)岁;Judet分型,Ⅲ型15例,Ⅳ型8例。比较两组手术时间、术中透视次数,采用Metaizeau评价标准评估骨折复位情况,Tibone-Stoltz标准评价两组肘关节功能恢复情况。结果:两组患儿获得随访,时间12~24(16.56±6.34)个月。弹性钉组手术时间、术中透视次数分别为(56.64±19.27)min、(21.13±7.87)次,关节造影结合弹性钉组手术时间、术中透视次数为(40.33±11.50)min、(12.10±3.52)次,两组比较差异有统计学意义(P<0.05)。根据Metaizeau评价标准,关节造影结合弹性钉组优11例,良9例,可3例,差0例;弹性钉组优5例,良13例,可4例,差1例;两组比较,差异有统计学意义(P<0.05)。肘关节功能按照Tibone-Stoltz标准评价,关节造影结合弹性钉组优14例,良8例,可1例,差0例;弹性钉组优12例,良9例,可1例,差1例;两组比较,差异无统计学意义(P>0.05)。结论:关节造影辅助下闭合复位经皮弹性髓内钉内固定术较经皮弹性髓内钉内固定术具有手术时间短、术中透视次数少,骨折复位良好的优势,关节造影可将儿童桡骨头颈骨软骨等解剖结构显影,充分显示骨折复位及肱桡关节对位情况,更精准地指引弹性髓内钉植入桡骨颈的深度,提高手术效率和成功率。Objective To explore clinical effect of closed reduction percutaneous elastic intramedullary nail assisted by arthrography in the treatment of radial neck fracture in children.Methods A retrospective analysis was performed on 23 children with radial neck fracture treated with arthrography assisted closed reduction and percutaneous elastic intramedullary nail internal fixation(arthrography with elastic nail group)from January 2019 to December 2022,including 12 males and 11 females,aged from 2 to 12 years old with an average of(7.36±1.89)years old;According to Judet fracture types,14 children were typeⅢand 9 children were typeⅣ.In addition,23 children with radial neck fracture were selected from January 2015 to December 2018 who were treated with closed reduction and percutaneous elastic intramedullary nail fixation(elastic nail group),including 11 males and 12 females,aged from 2 to 14 years old with an average of(7.50±1.91)years old;Judet classification included 15 children were typeⅢand 8 children were typeⅣ.Operative time and intraoperative fluoroscopy times were compared between two groups.Metaizeau evaluation criteria was used to evaluate fracture reduction,and Tibone-Stoltz evaluation criteria was used to evaluate functional recovery of elbow between two groups.Results Both groups were followed up for 12 to 24 months with an average of(16.56±6.34)months.Operative time and intraoperative fluoroscopy times of elastic nail group were(56.64±19.27)min and(21.13±7.87)times,while those of joint angiography with elastic nail group were(40.33±11.50)min and(12.10±3.52)times;there were difference between two groups(P<0.05).According to Metaizeau evaluation,11 patients got excellent result,9 good and 3 fair in joint angiography with elastic nail group,while in elastic nail group,5 excellent,13 good,4 acceptable,and 1 poor;the difference between two groups was statistically significant(P<0.05).According to Tibone-Stoltz criteria,14 patients got excellent result,8 good,and 1 fair in joint arthrography with

关 键 词：关节造影 弹性髓内钉 儿童 桡骨颈骨折 

分 类 号：R726.8[医药卫生—儿科]