外固定支架治疗儿童前臂远端双骨折

Treatment of the distal forearm fractures by external fixator in children

目的探讨应用外固定支架治疗儿童前臂远端双骨折的可行性及临床应用价值。方法前臂远端骨折患儿14例,均为尺桡骨完全骨折;开放性骨折6例,闭合性骨折8例。采用外固定支架固定或结合有限内固定进行治疗。结果术后随访4～43个月,平均12.7个月。X线片显示骨折全部愈合,骨折愈合时间为6～8周,平均6.9周;尺桡骨轴向无短缩;骨间距恢复;无骨不连、骨折畸形愈合或交叉骨性愈合等。对患儿肘、腕关节和前臂的活动度以及患肢肌肉力量测量并进行功能评定:优11例(78.6%),良3例(21.4%)。未发生医源性神经血管损伤、感染、螺钉松脱、骨折再移位、再骨折等并发症。结论对儿童前臂远端双骨折畸形矫正能力应进行综合判断;对开放性骨折、不稳定性骨折、不能耐受闭合复位、不能接受闭合复位、闭合复位失败以及再发移位的患儿,采用外固定支架进行短期固定后辅以石膏外固定,是一种操作简单、安全、损伤小、疗效好的治疗方法。

Objective To evaluate the results of external fixator in treating the distal forearm fractures in children. Methods Fourteen children with distal fractures of both forearm bones were treated with either external fixator alone or external fixator combined with limited internal fixation. There were 12 boys and 2 girls with an average age of 12.3 years （range 8-16 years）. Results All patients were followed up for 4 to 43 months （average 12.7 months）. Good union was achieved in all 14 cases after 6. 9 weeks （range 6-8 weeks）. There was no ulna or radius shortening. The interosseous space was restored on the X-rays in all cases, There was no nonunion, malunion, or cross-union. The range of movements of the wrist, elbow and forearm were assessed with a geniometer. The muscle strength of the arm was excellent in 11 and good 3 patients. There was no complication. Conclusions Distal forearm fractures in children could be safely managed with external fixator combined with plaster. The results were good with minimal complication.