O’Brien II、III型儿童桡骨颈骨折的治疗

Treatment of O'Brien type II and type III radial neck Fracture in children

目的分析手法整复、经皮克氏针撬拨复位、弹性髓内钉复位固定和切开复位治疗O’Brien II、III型儿童桡骨颈骨折的疗效。方法 2010年1月至2012年12月共收治O’Brien II、III型的桡骨颈骨折25例,平均年龄7.6岁,其中男16例,女9例;左侧11例,右侧14例。O’Brien分型:II型18例,III型7例。合并尺骨近端骨折2例,合并肘关节脱位1例。根据病情分别采用上述四种方法治疗,评估治疗效果。结果所有病例骨折均于术后2个月内愈合。根据Tibone和Stoltz的评估标准进行评价,25例中有3例O’Brien II型骨折手法整复成功,效果均为优;4例O’Brien II型桡骨近端干骺端骨折采用弹性髓内钉复位后固定,效果均为优;2例合并尺骨近端骨折、1例合并肘关节脱位的病例采用切开复位、克氏针固定术治疗,2例效果为良,1例为差;余15例(O’Brien II型10例、III型5例)采用经皮克氏针撬拨复位、内固定术治疗,13例效果为优,2例为良。结论经皮克氏针撬拨复位具有复位成功率高、创伤小、并发症少、术后疗效好等优点,是绝大多数O’Brien II、III型儿童桡骨颈骨折治疗的首选方法。

Objective To analysis the results of treatment of radial neck fracture of o’ Brien type ii and iii in children by close reduction, elastic stable intramedullary nail(Esin) , percutaneous Kirshnecs wire leverage(PKWl) and open reduction. Method from January 2010 to december 2012, 25 cases of radial neck fracture of o’Brien type ii and iii in children were treated.16 were male and 9 were female, with a mean age of 7.6 years. There were 11 left arms and 14 right arms. concomitant injuries included proximal ulna fractures in 2 cases,elbow dislocation in one case. They were treated by close reduction, Esin, PKWl and open reduction respectively according to their conditions. Result fracture healing in all cases were observed within 2 months. according to Tibone and stoltz function scale, of the 25 cases, 3 of o’Brien type ii were successfully reduce by close reduction, and the results of them were excellent. 4 cases of o’Brien type ii proximal metaphysis fracture of radius were treated by Esin, and the results of them were excellent. 2 cases combined with proximal ulna fractures and one case combined with elbow dislocation were treated by open reduction, 4 were good and one fair. 15 cases(o’Brien type ii 10 cases,type iii 5 cases) were treated by PKWl,13 were excellent, 2 were good. Conclusion majority of radial neck fractures in children can be reduced by PKWl with little invasion , few complications and good postoperative result,PKWl is the preferred treating method for majority of o’Brien type ii and type iii radial neck fractures in children.