经皮撬剥复位弹性髓内针固定治疗儿童桡骨颈骨折的疗效

 目的 探讨经皮克氏针撬剥复位弹性髓内针内固定治疗儿童JudetⅢ型、Ⅳ型桡骨颈骨折的手术方法、临床疗效。方法 对首都医科大学附属北京儿童医院2009-01至2017-01采用经皮克氏针撬剥复位弹性髓内针内固定治疗的儿童桡骨颈骨折临床资料进行回顾性病例分析。依据Judet分型对病例进行分型,JudetⅢ型、Ⅳ型患儿采用手术治疗,术后依据Metaizeau整复标准评估手术复位效果,末次随访按 Metaizeau 疗效标准评估患儿预后情况。结果 所有患者均获得随访,随访时间(36.98±18.98)个月(9～100个月)。按Judet分型:Ⅲ型44例,Ⅳa型9例,Ⅳb型7例。单纯桡骨颈骨折41例,18例合并尺骨鹰嘴骨折,1例合并肱骨内上髁骨折。按 Metaizeau 的整复标准,其中优48例,良12例,一般0例,差0例。按Metaizeau疗效标准,优55例,良5例,一般0例,差0例。结论 经皮克氏针撬剥复位弹性髓内针固定桡骨颈骨折手术操作简单,复位效果满意,固定效果可靠,术后可早期活动,肘关节功能恢复好,是一种治疗儿童桡骨颈骨折切实可行的方法。

Percutaneous reduction and elastic stable intramedullary nail fixation for pediatric radial neck fractures

Objective To investigate the methods and therapeutic efficacy of percutaneous reduction and elastic stable intramedullary nail fixation for pediatric radial neck fractures.Methods A retrospective analysis was conducted of the clinical data on radial neck fractures treated with percutaneous reduction and elastic stable intramedullary nail fixation in Beijing Children’s Hospital between January 2009 and January 2017. According to the Judet system, children of Judet Ⅲ and Ⅳ were treated by surgery. The effects of surgical reduction were evaluated according to the Metaizeau reduction standard, and the prognosis was evaluated according to the standard of Metaizeau in the last follow-up.Results All the patients were followed up for (36.98±18.98) months (9-100 months). A total of 60 patients were enrolled in this study, 25 males and 35 females. The median age was (7.27±2.76) years (ranging from 2 to 12 years). According to the Judet system, there were 44 cases of type Ⅲ, 9 cases of type Ⅳa, and 7 cases of type Ⅳb. There were 41 cases of simple radial neck fractures, 18 cases complicated with olecranon fractures and 1 case with the medial epicondyle fracture. According to Metaizeau reduction standard, the effect was excellent in 48 cases, good in 12 cases, insignificant in 0 case and poor in 0 case. According to clinical classification of Metaizeau, the effect was excellent in 55 cases, good in 5 cases, insignificant in 0 case and poor in 0 case.Conclusions Percutaneous reduction and elastic stable intramedullary nail fixation is effective in the treatment of pediatric radial neck fractures,with advantages of less epiphyseal injury,stable fixation,early post-operative training and good elbow joint function recovery.