弹性髓内钉去弹性化治疗儿童桡骨干远段骨折

Pre-bend elastic stable intramedullary nail fixation for distal radial shaft fractures in children

目的 应用弹性髓内钉去弹性化技术治疗儿童桡骨干远段骨折,观察临床疗效、放射学结果 及预后功能情况.方法 自2006至2008年,应用闭合复位、弹性髓内钉去弹性化技术治疗儿童桡骨干远段骨折18例,男13例,女5例;年龄5～15岁,平均9岁8个月.所有病例均为闭合性骨折,从受伤到接受手术治疗的时间为1～9d.骨折部位均位于桡骨干远段1/3,15例合并同侧尺骨骨折,另外3例为单纯桡骨骨折.复位方式均为＂C＂型臂X线机透视下闭合复位.术后常规长臂功能位石膏管型固定3～周.结果 最短随访时间12个月,平均骨折完全愈合时间为5个月（3～7个月）.术后骨折对位正位平均93.2%±5.9%,侧位平均95.7%±7.1%;术后成角正位平均2.7°±1.5°,侧位平均1.4°±1.2°.94%（17/18）的患儿最终恢复了完全的前臂旋转功能,1例患儿存在10°以内的前臂旋转受限,随着随访时间延长,逐步好转中.并发症包括1例患儿出现髓内钉钉尾软组织激惹症状,1例患儿进钉部位手术瘢痕皮肤敏感.结论 弹性髓内钉去弹性化技术对于治疗儿童桡骨干远段骨折是一种有效、安全且方便可行的方法 .

Objective To investigate the functional and radiographic outcomes of pre-bent elastic stable intramedullary nail in treatment of distal radial shaft fractures in children. Methods From January 2006 to December 2008, 18 children with distal radial shaft fracture were treated by close reduction and internal fixation with a pre-bent elastic stable intramedullary nail. The age range was from 5 years to 15 years,with an average of 9 years and 8 months. All the cases were closed fractures, and followed up at least 12 months. The time interval from injury to surgery were 1 to 9 days. Fracture sites were located at the distal radial shaft. Among them, 15 cases suffered ipsilateral ulnar fracture, and the others for solitery radial fracture. Closed reductions were performed under C-arm fluoroscopy. All affected arms were immobilized in the functional position postoperatively by the plaster cast beyond elbows. Results The average time of fracture complete union was 5 months （ranged from 3 months to 7 months）. The average preoperative angulation of the fractures： anteroposterior view 16.2±7.5 degrees, lateral view 26.2±13.1 degrees. The average postoperative angulation of the fractures： anteroposterior view 2.7±1.5 degrees, lateral view 1.4±1.2 degrees. All fractures maintained good alignment postoperatively, and 94.4% （17/18） of the patients regained a full range of rotation of the forearm. One patient suffered limitation of rotation in forearm less than 10°, and this had improved by final follow-up. Complications included soft tissue irritation at the site of nail insertion in one patient and transient scar hypersensitivity in another. Conclusion Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children.