微创克氏针置入并外固定架修复桡骨远端不稳定骨骺骨折

背景：单纯使用克氏针或外固定架治疗桡骨远端骨骺骨折的临床实践中，仍存在桡骨短缩、骨折移位等固定后并发症，尤其在不稳定骨骺骨折情况下。克氏针主要治疗桡骨远端骨折，对其骨骺骨折使用相对较少。 目的：观察外固定支架结合经皮克氏针复位固定微创治疗桡骨远端不稳定性骨骺骨折的临床效果。 方法：对90例桡骨远端骨骺骨折患儿行固定治疗，在不切开情况下微创闭合复位骨折骨骺，随机分成2组，对照组采用单纯跨腕关节外固定支架固定方案；观察组采用跨腕关节外固定支架结合经皮克氏针闭合帮助复位固定骨骺骨折方案。固定后行腕关节功能锻炼，分别于固定后9周及24个月随访观察。对比两组患者固定后中远期的临床疗效、腕关节功能恢复及X射线检查情况。 结果与结论：固定后24个月随访按Cooney标准评定腕关节功能，对照组优良率77%，X射线评定优良率63%；观察组腕关节功能优良率93%，X射线评定优良率为90%，两组差异具有显著性意义(P < 0.01)。两组骨骺骨折患者均获临床骨愈合，腕关节均功能恢复。提示外固定支架结合克氏针闭合复位微创治疗桡骨远端不稳定骨骺骨折，可应用克氏针辅助复位掌倾角及尺偏角，治疗简单，固定可靠，腕关节功能恢复良好，骨骺畸形愈合并发症少，固定后基本生活学习功能恢复正常，疗效稳定满意，其临床疗效明显优于单纯跨外固定支架固定。

Minimally invasive Kirschner wire combined with external fixation for repair of unstable distal epiphyseal fracture of radius

BACKGROUND: Postoperative complications, such as radial shortening and displacement of fractures, still exist in the clinical practice of treatment of distal radius fracture with only Kirschner wire or external fixation, especially in the treatment of unstable epiphyseal fracture. Kirschner wire is mainly indicated in distal radius fracture and it is rarely applied on the treatment of epiphyseal fracture. OBJECTIVE: To explore the clinical curative effects of the minimally invasive treatment of unstable distal epiphyseal fracture of radius with the combination of external fixation and reduction and percutaneous Kirschner wire fixation. METHODS: Implement surgical treatment on 90 children having distal epiphyseal fractures of radius with no cut by minimally invasive closure and reduction of epiphyseal fractures. Two treatment methods were used: in control group, external fixation of only across carpal joint, external fixation of across carpal joint and percutaneous Kirschner wire fixation were used in the observation group. All cases were followed up at 9 weeks and 24 months after fixation. The long-dated clinical curative effects after surgical operation, functional recovery and the change of X-ray films were compared. RESULTS AND CONCLUSION: According to Cooney rating criteria, the good to excellent rate of the control group was 77%. According to X-ray evaluation, the good to excellent rate was 63.33%. The good to excellent rate of the observation group was 93% and 90 % according to Cooney rating criteria and X-ray evaluation. The difference was significant between two groups (P < 0.01). All the cases got the clinical healing of bones and recovery of wrist joint function. Studies show that: In the minimally invasive surgical treatment of unstable distal epiphyseal fracture of radius with the combination of external fixation and reduction and percutaneous Kirschner wire fixation, K-wire helps the reduction with appropriate palmar inclination and ulnar deviation. Cured by external fixation, static fixation of fractures with the help of K-wire and dynamic transarticular fixation, the patients have a simple postoperative treatment with reliable fixation, good shape, fair recovery of function and few complications of epiphysis malunion. The basic learning function returns to normal after surgical treatment and the curative effects are stable and satisfactory.