Metaizeau法联合驱血止血带治疗儿童重度移位桡骨颈骨折  

Metaizeau technique combined with Esmarch tourniquet in children with displaced radial neck fracture

作　　者：曾慧意 蔡秀英 卢晓坤 叶萍萍 李炳钻 王建嗣 ZENG Hui-yi;CAI Xiu-ying;LU Xiao-kun;YE Ping-ping;LI Bing-zuan;WANG Jian-si(Department of Pediatric Orthopedics,Quanzhou Orthopedic-Traumatological Hospital,Quanzhou,Fujian,362000,China)

机构地区：[1]泉州市正骨医院小儿骨科,福建省362000

出　　处：《中国骨与关节杂志》2025年第4期343-347,共5页Chinese Journal of Bone and Joint

基　　金：2022年度福建中医药大学校管临床专项资助(XB2022103)。

摘　　要：目的探讨应用Metaizeau法联合驱血止血带(Esmarch tourniquet)治疗儿童JudetⅢ、Ⅳ型桡骨颈骨折的疗效与可行性。方法收集2022年4月至2024年2月我院收治资料完整随访详实的JudetⅢ、Ⅳ型桡骨颈骨折的65例患者,其中男33例,女32例,年龄3~12岁,平均(8.33±2.83)岁;JudetⅢ型45例,Ⅳ型20例。根据不同治疗方法分为Esmarch tourniquet(试验组,n=21)和克氏针撬拨复位(对照组,n=42),通过对手术时间、骨折愈合情况、术后并发症、骨折复位标准(Metaizeau标准)以及肘关节功能(Mayo功能评分)等进行分析比较。结果术后所有病例均获得随访,随访时间为2~9个月,平均(4.11±1.61)个月。试验组手术时间[(77.62±34.11)min]与对照组[(65.00±21.87)min]比较差异无统计学意义(t=1.001,P=0.339)。试验组骨折愈合时间(5.22±1.563)个月与对照组(4.04±0.99)个月比较差异无统计学意义(t=2.109,P=0.06)。根据Metaizeau评价标准及Mayo肘关节功能评估标准分析,两组疗效比较差异无统计学意义(χ~2=0.54,P=0.817)。在术后神经损伤的评估中,对照组出现7例术后神经损伤表现,但均在术后3个月恢复;而试验组则未见明显神经损伤及皮肤坏死现象,两者并发神经损伤情况差异有统计学意义(χ~2=3.938,P=0.043)。术后所有病例均无桡骨头缺血性坏死发生。结论Esmarch tourniquet可明显减少神经损伤风险,因此可作为JudetⅢ、Ⅳ型桡骨颈骨折治疗的辅助方法,从而为儿童桡骨颈骨折的治疗开拓新思路。Objective To investigate the feasibility and treatment effect of using Esmarch tourniquet combined with Elastic Stable Intramedullary Nailing(ESIN)in children with JudetⅢand JudetⅣradial neck fracture.Methods A retrospective analysis was conducted from April 2022 to February 2024,including 65 children(33 males and 32 females)with a median age of(8.33±2.825)years(range:3-12 years).According to the Judet classification,45 fractures were classified as typeⅢand 20 as TypeⅣ.The patients were divided in two groups according to different treatment methods:Esmarch tourniquet group(test group,n=21)and Kirschner wire group(control group,n=42).The study recorded the surgical time,reduction time,reduction quality evaluated according to the Metaizeau radiological standard,and elbow joint function evaluated according to the Mayo Elbow Performance index.Results All patients were available for an average follow up of(4.11±1.61)months(range:2-9 months).No significant difference was observed between K-wire fixation and Esmarch tourniquet at surgical duration[(77.62±34.11)minutes vs.(65.00±21.87)minutes.(t=1.001,P=0.339)],and healing time[(5.22±1.563)months vs.(4.04±0.99)months,(t=2.109,P=0.06)].Meanwhile,there was no significant difference in the Metaizeau radiological standard,and elbow joint function evaluated according to the Mayo Elbow Performance index(χ^(2)=0.54,P=0.817).In the evaluation of postoperative nerve injury,the control group had 7 cases of postoperative nerve injury,but all recovered 3 months later with no obvious nerve injury and skin necrosis.The nerve injury was higher in the K-wire fixation group compared to Esmarch tourniquet group(χ^(2)=3.938,P=0.043).Conclusions Esmarch tourniquet can avoid the nerve injury.It might be a choice for the treatment of displaced radial neck fractures in children.

关 键 词：儿童 桡骨骨折 止血带 骨折复位 

分 类 号：R683.4[医药卫生—骨科学]