经皮克氏针翘拨复位顺行弹性髓内钉治疗儿童桡骨远端骨折  

Percutaneous Kirschner Wire Poking Reduction and Antegrade Elastic Stable Intramedullary Nail for the Treatment of Distal Adius Fractures in Children

作　　者：车伟 陈进 王雷 朱庆华 CHE Wei;CHEN Jin;WANG Lei;ZHU Qinghua(Department of Pediatric Orthopedics,the First Affiliated Hospital of Wannan Medical College,Wuhu 241000 China)

机构地区：[1]皖南医学院第一附属医院小儿外科,安徽芜湖241000

出　　处：《锦州医科大学学报》2024年第6期62-67,共6页Journal of Jinzhou Medical University

基　　金：安徽省高校自然科学研究项目,项目编号:KJ2021A0830。

摘　　要：目的探讨经皮克氏针翘拨复位,从桡骨近端入路采用顺行弹性髓内钉(elastic stable intramedullary nailing,ESIN)治疗儿童桡骨远端干骺端和干骺交界处(distal radius diaphyseal-metaphyseal junction,DRDMJ)骨折的临床疗效。方法回顾性分析自2021年11月至2022年11月采用顺行ESIN治疗儿童桡骨远端干骺端和DRDMJ骨折患者的临床资料,定期随访患者骨折愈合情况,以及前臂旋转活动、肘关节屈伸活动情况。采用Gartland-Werley腕关节功能评分,对腕关节功能进行评估。同时,在ESIN取出前和取出后随访中,测量受伤前臂的旋转活动范围,并与未受伤侧进行比较。结果21例患者均顺利完成手术并获得随访,随访时间6~12个月,平均9.5个月。术后8~16周,骨折均达到临床愈合。术后所有患者均无桡神经损伤、皮肤激惹症状发生。影像学上,未发生骨折再移位、内固定脱落、骨不连等。末次随访时,患者受伤前臂旋前和旋后活动范围与未受伤侧相比,无前臂旋转丢失,差异无统计学意义(P>0.05)。21例患者Gartland-Werley腕关节功能评分,其中优21例,良0例,优良率100%。结论经皮克氏针翘拨复位顺行ESIN治疗儿童桡骨远端(干骺或交界处)骨折,具有微创、固定牢靠、并发症少,腕关节、前臂旋转功能恢复良好等优点,是治疗该类骨折的有效方法。Objective To investigate the clinical efficacy of percutaneous Kirschner wire poking reduction and anterograde elastic stable intramedullary nail(ESIN)treatment for radial diaphysis and distal radius diaphyseal metaphyseal junction(DRDMJ)fractures in children through a proximal radius approach.Methods A retrospective analysis was conducted on the clinical data of children with distal radius metaphyseal and DRDMJ fractures treated with anterograde ESIN in the Department of Pediatric Orthopedics of the First Affiliated Hospital of Wannan Medical College from November 2021 to November 2022.The fracture healing status,forearm rotation activity,and elbow joint flexion and extension activity were regularly followed up.The Gartland Werley wrist joint function score was used to evaluate wrist joint function.Simultaneously,during the follow-up before and after removing the ESIN,the rotational activity range of the injured forearm was measured and compared with the uninjured side.Results All 21 patients successfully completed the surgery and were followed up for 6-12 months,with an average of 9.5 months.After 8-16 weeks of surgery,all fractures achieved clinical healing.No radial nerve injury or skin irritation symptoms occurred in all postoperative patients.In terms of imaging,there were no cases of fracture displacement,internal fixation detachment,or bone nonunion.At the last follow-up,there was no loss in pronation and supination activity range of the injured forearm compared to the uninjured side,and the difference was not statistically significant(P>0.05).The Gartland Werley wrist joint function score of 21 patients showed excellent results in 21 cases and good results in 0 cases,with an excellent and good rate of 100%.Conclusion The treatment of distal radius fractures in children,especially DRDMJ fractures,with percutaneous Kirschner wire poking reduction and anterograde ESIN has the advantages of minimally invasive,reliable fixation,fewer complications,and good recovery of wrist and forearm rotation function.It is

关 键 词：儿童 桡骨远端骨折 弹性弹性钉 

分 类 号：R683[医药卫生—骨科学]