单根与双根弹性髓内钉治疗学龄期儿童尺桡骨双骨折的对比研究

Comparison study of single and double elastic stable intramedullary nailing for the treatment of both bone forearm fractures in school-age children

目的对比分析应用单根弹性髓内钉固定桡骨与双弹性髓内钉固定尺桡骨治疗学龄期儿童尺桡骨双骨折的疗效。方法对2005年2月至2009年2月收治的32例手法复位失败或不稳定型的学龄期（5-12岁）儿童尺桡骨双骨折进行对比研究。其中15例仅行单根弹性髓内钉固定桡骨（SESIN组），17例行双弹性髓内钉固定尺桡骨（D-ESIN组），对两组病例手术时间及住院费用，术后影像学结果、临床疗效结果及并发症进行对比分析。结果相对于DESIN组，S-E-SIN组的手术时间较短、住院费用较低，两项比较差异均有统计学意义。D-ESIN组术后3个月尺骨愈合率70．6％，要低于S-ESIN组的100％，差异有统计学意义。末次随访时，两组在尺、桡骨成角畸形，前臂旋转受限及并发症发生率上比较，差异均无统计学意义。S-ESIN组长臂石膏托需固定4～6周，平均时间长于D-ESIN组的2～4周。结论从手术时间、术中c臂辐射量、住院费用、临床疗效及并发等方面进行综合比较，采用单根弹性髓内钉固定桡骨的方法有一定的优越性，是治疗学龄期儿童尺桡骨双骨折的一种有效方法；而双弹性髓内钉固定更加稳定，有利于早期功能锻炼。

Objective To evaluate and compare the outcomes of single and double elastic stable intramedullary nailing for the treatment of both bone forearm fractures in school-age （5-12 years old） children. Methods From February 2005 to February 2009, clinical data of 32 school-age children with both-bone forearm fractures and underwent surgery at this center were retrospectively analyzed. Among these patients, 15 were treated with single elastic stable intramedullary nailing to fixate the radius only （Group S-ESIN）, and the other 17 patients were treated with double elastic stable intramedullary nailing to fixate both the radius and ular （Group DESIN）. All the patients were followed up. Their surgery duration, hospitalization cost, radiographic outcomes, the clinical outcomes and postoperative complications were statistically analyzed. Results Group S-ESIN patients had less surgery durations and lower hospitalization costs than Group D-ESIN patients. The rates of fracture union of ular at 3 months after surgery in the patients of Group D-ESIN were significant lower than those of Group S-ESIN（P〈0. 05）. No significant difference of forearm angulations deformation, forearm rotation dysfunction and complications was found between the 2 groups. Conclusions Single and double elastic stable intramedullary nailing have its own advantages, and both of them are effective for the treatment of both bone forearm fractures in school-age children. Surgical strategy should be made individually based on patients＇ conditions.