儿童桡骨远段骨不连并重度腕部畸形的手术治疗

Surgical treatment of distal radius nonunion accompanied with severe wrist deformity in children

目的探讨小儿桡骨远段骨不连并腕部畸形的治疗方法。方法收治小儿桡骨远段骨不连并腕部畸形9例，其中开放性骨折合并感染7例，闭合性骨折2例。全部采用尺骨缩短、桡骨撑开植骨延长手术治疗。结果术后随访6～30个月，平均22个月，骨不连全部愈合。8例取得良好外观和满意功能。术后感染1例，经治疗后愈合。腕部畸形复发1例，经再次行尺骨缩短联合远端骨骺阻滞术后改善。结论治疗成功的关键是保证尺桡骨同步发育、促进骨折愈合和矫正畸形，尺骨缩短、桡骨撑开植骨延长是一种可行的方法。

Objective To explore the treatment methods of distal radius nonunion combined with wrist deformity in children. Methods Nine cases of distal radius nonunion accompanied with wrist deformity were treated, among which 7 had open fractures and infections while the other 2 were closed fractures. All cases were surgically treated by ulna shortening and radius lengthening with bone graft. Results Postoperatively the patients were followed up for 6 to 30 months, with an average of 22 months. All the fractures were healed. Eight had good appearance and function. Postoperative infection was seen in one patient that was cured with antibiotics treatment. Recurrence of wrist deformity occurred in one patient, who underwent a second surgery of ulnar shortening and arrest of distal epiphysis. Conclusion Ulna shortening and radius lengthening with bone graft is an effective procedures to treat children with distal radius nonunion and wrist deformity. The key to success is to ensure synchronized growth of the ulnar and radius, enhance fracture healing and correct deformity.