三种内固定方式治疗大龄儿童尺桡骨双骨折的前瞻性对比研究

Prospective comparative study of three internal fixation methods for treatment of both-bone forearm fractures in older children

目的对应用尺骨加压钢板与桡骨弹性髓内钉、双弹性髓内钉、双钢板三种不同内固定方式治疗大龄（10-16岁）儿童尺桡骨双骨折的疗效进行对比分析．方法对2004年2月-2008年6月收治的45例手法复位失败或不稳定型的大龄儿童尺桡骨双骨折进行前瞻性随机对照研究。分为尺骨加压钢板与桡骨弹性髓内钉固定组（A组）、双弹性髓内钉固定组（B组）、双钢板固定组（c组）3组，每组15例。分别对3组患者术中及住院期间的各项指标，术后的影像学结果、临床疗效结果及并发症进行对比分析。结果三组相比．A、B两组手术时间相对较短、术中出血量较少，与C组相比差异均有统计学意义，而A、B两组之间差异无统计学意义；B组术中上止血带时间最短，A组次之，C组最长．三组间两两比较差异均有统计学意义；A、B、C三组在术后5d疼痛评分两两比较，差异均无统计学意义。A组3个月骨折愈合率高于B组，差异有统计学意义；而B组与c组、A组与C组间差异均无统计学意义。三组在术后6个月骨折愈合率比较差异无统计学意义。在前臂旋转受限及并发症发生率上，A组最低，B组次之，C组最高，但三组间两两比较差异无统计学意义。结论从手术创伤、骨折愈合率、临床疗效及并发症等方面进行综合比较，采用尺骨加压钢板与桡骨弹性髓内钉的内固定方式有优越性，是治疗大龄儿童尺桡骨双骨折的一种有效方法。而双弹性髓内钉内固定具有更能体现微创化、二期取出内固定方便的优点。

Objective To evaluate and compare the outcomes of three internal fixation methods, ulna compression plate and radial elastic stable intramedullary nailing （ESIN）, double ESIN and double plating, for the treatment of both-bone forearm fractures in older children. Methods From February 2004 to July 2008, 45 older children with both-bone forearm fractures that failed manual closed reduction or were unstable were recruited for the prospective comparative study. They were randomized into 3 groups with 15 each： who were treated with ulna compression plate and radial elastic stable intramedullary nailing （ESIN） （group A）, double ESIN （group B） and double plating （group C）. The intraoperative and perioperative indexes, the radiographic findings, the clinical outcomes and postoperative complications were compared. Results Group A and group B resulted in a lower blood loss and shorter surgery time than group C （statistically significant ）. However no significant differences were found between group A and group B. There was statistically significant difference on tourniquet use time among the three groups, group B being shorter than group A and group C. There was no significant difference on postoperative pain score within 5 days ＇after the surgery among the three groups. Fracture union rate of group A at 3 months was significantly higher than group B, while no significant differences were found between group B and group C and between group A and group C. There was no statistically significant difference on fracture union among the three groups at 6 months. The incidence of loss of forearm rotation and complications was lower in group A than in group B and group C, however the difference was not statistically significant. Conclusion Based on surgery trauma, incidence of fracture union, clinical outcomes and complications, ulna compression plate and radial elastic stable intrameduUary nailing shows superiority in the treatment of both-bone forearm fractures in older children. However double ESIN has the advantages of being minimally invasive and easy for secondary hardware removal.