微型钢板置入固定治疗儿童尺、桡骨远端不稳定性骨折18例

A mini-plate fixation for the treatment of children's ulna and radius distal unstable fractures:A 18-case analysis

目的:观察微型钢板置入固定治疗儿童尺桡骨远端不稳定性骨折的临床疗效。方法:回顾性分析2006-08/2007-09华中科技大学同济医学院附属武汉妇女儿童医院骨科收治的尺、桡骨远端不稳定性骨折患儿18例,男15例,女3例;年龄4岁1个月～13岁3个月,平均9岁8个月,右侧9例,左侧9例;均采用微型钢板代替克氏针置入内固定治疗。术前根据骨折类型和部位选择合适的成人指骨、掌骨、跖骨微型不锈钢或钛钢板,测量骨折线距骺板的距离准备T型、L型、三叶草型或直型钢板。术后及随访时观察关节功能、前臂旋转丢失的程度、骨愈合情况及并发症的发生。结果:全部病例均在门诊获得随访,随访时间平均26.4个月。18例患儿前臂旋前功能有平均10°的受限,功能锻炼后基本恢复,不影响日常活动。旋后功能及腕关节屈伸功能基本恢复正常,骨折全部愈合。无再移位和再骨折、无畸形愈合、延迟愈合以及骨桥形成等并发症,也未见血管和神经损伤。结论:对不能满意复位、复位后不能维持稳定再次移位或陈旧性尺桡骨远端不稳定性骨折,需要开放复位者,用微型钢板内固定避免对前臂远端骨骺的损伤,术后并发症少,只要选择好合适的微型钢板,则可以代替传统的克氏针内固定。

OBJECTIVE： To observe the clinical effect of mini-plate fixation on the treatment of children unstable fractures of the distal ulna and radius. METHODS： A total of 18 children with unstable fracture of the distal ulna and radius （15 boys and 3 girls, aging 4.1-13.3 years, with the mean age of 9.8 years） were selected from Department of Orthopaedics, Wuhan Children and Women＇s Hospital, Tongji Medical College, Huazhong University of Science and Technology from August 2006 to September 2009. The fracture occurred on right side （n=-9） and left side （n=-9）. All children were treated with mini-plate fixation which was instead of the traditional pinning fixation. Before operation, stainless steel or titanium plates of adult digital bone, metacarpal bone, and metatarsal bone were chosen according to fracture types and sites. The distance from fracture line to epiphyseal plate was measured to get ready the T-, L-, clover or straight plates. Joint function, degree of forearm rotation loss, bone healing, and complications were monitored postoperatively and within following up. RESULTS： All cases were followed up in out-patient for an average 26.4 months. An average 10° limitation was measured on forearm pronation function of all children, but the function was recovered by doing exercises which did not influence daily activities. Supination, flexion and extension of wdst joint were generally normal, and the fracture was generally healed. Complications including re-displacement, refractura, malunion, delayed union, bone bridge formation, vascular and nerve injury were not found. CONCLUSION： Patients who were not satisfied with the reduction, re-displacement, or old distal radius fracture needed an open reduction. Micro-plate was fixed to avoid epiphyseal injury of distal forearm and reduce postoperative complications. An ideal mini-plate may replace the traditional pinning fixation.