弹性髓内钉与加压钢板治疗儿童尺桡骨双骨折的比较

目的 比较弹性髓内钉(ESIN)与加压钢板治疗不稳定型及手法复位失败的儿童尺桡骨双骨折的疗效.方法 自2004年2月至2007年12月,按一定的入选标准和排除标准,回顾分析50例手术治疗的儿童前臂尺桡骨双骨折,其中22例行ESIN内固定,28例行加压钢板内固定,对两组进行半年以上的随访,并对两组术中结果、术后的影像学结果、临床疗效结果及并发症进行对比分析.结果 ESIN组在手术时间上短于钢板组,差异有统计学意义;两组术中出血量比较差异无统计学意义.ESIN组和钢板组术后3个月桡骨愈合率分别为81.8%和71.4%.术后6个月尺骨愈合率分别为95.5%和96.4%、桡骨愈合率分别为100%和96.4%,前臂旋转受限发生率分别为18.2%和21.4%,并发症发生率分别为13.6%和17.9%,差异均无统计学意义.而ESIN组和钢板组术后3个月尺骨愈合率分别为36.4%和71.4%,两组差异均有统计学意义(P<0.05).末次随访时,ESIN组和钢板组最大桡骨弓大小分别为(7.0±3.5)%及(6.8±2.4)%,两组差异无统计学意义;而最大桡骨弓位置分别为(71.2±7.8)%及(63.8±3.6)%,两组差异有统计学意义(P<0.05),钢板组更接近正常儿童组.结论 弹性髓内钉在治疗儿童前臂尺桡骨双骨折中,具有微创,手术时间短,二期取出内固定方便等优点,但存在尺骨延迟愈合及不愈合的风险.

Elastic stable intramedullary nailing and compression plating for both-bone forearm fractures in children

Objective To compare the clinical outcomes for treating unstable or irreducible both-bone forearm fractures in children with elastic stable intramedullary nailing (ESIN) and compression plating. Methods From Feb, 2004 to Dec, 2007, fifty operation children with both-bone forearm fractures which were followed up for more than half a year were retrospectively analyzed. Twenty two children in Group Ⅰ were treated with elastic stable intramedullary nailing (ESIN), and the other 28 in Group Ⅱ were treated with compression plating. The indexes of operation time, hospital stay, radiographic outcomes, clinical outcomes and complications were compared. Results Duration of operation was significantly shorter in the ESIN group, but no significant difference of operative blood loss was noted between these two groups. No significant differences were found between the groups for fracture union of radial at 3 months (81.8% in ESIN group, 71.4% in plating group), fracture union of radial and ulna at 6 months (95.5% vs. 96. 4%), forearm rotation on latest follow-up (18. 2% vs. 21.4%) and complications (13.6% vs. 17. 9%). The fracture union rate of ulna at 3 months in ESIN group was significant lower than plating group (36. 4% vs. 71.4%, P<0. 05). At latest follow-up, maximum radial bow magnitude was similar in the 2 groups(7. 0% ± 3. 5% vs. 6. 8% ± 2. 4%). However, the location of maximum radial bow in ESIN group was significantly different from the plating group (71.2% ± 7. 8% vs. 63.8% ± 3. 6%), location in the plating group were nearer to the reported norreal values (P<0. 05). Conclusions ESIN is an attractive treatment option for irreducible or unstable both-bone forearm fractures in children. It has the advantages of short operation time, minimally invasive and convenient removal of the nailing, but the delayed union and non-union of the ulna should be avoided.