经皮撬拨复位固定、切开复位固定及弹性髓内钉间接固定治疗儿童严重移位桡骨颈骨折的疗效比较

Closed reduction with joystick reduction,open reduction with kirschner wire,elastic intramedullary nailing fixation for treatment of radial neck fractures in children:a comparative study

背景:儿童桡骨颈骨折临床常见,对于JudetⅢ、Ⅳ度儿童桡骨颈骨折,其治疗方法有经皮撬拨复位克氏针固定、切开复位克氏针固定及弹性髓内钉间接复位固定治疗,何种方式最佳尚存争议。目的:比较儿童JudetⅢ度和Ⅳ度桡骨颈骨折的三种治疗方法。方法:2006年3月至2009年10月治疗JudetⅢ度和Ⅳ度桡骨颈骨折36例,男23例,女13例;年龄8～15岁,平均11.2岁;其中Ⅲ度27例,Ⅳ度9例。分别采用经皮撬拨复位克氏针固定18例,切开复位克氏针固定8例,弹性髓内钉间接固定10例。术后X线片按Metaizeau整复标准,术后3个月X线片按Metaizeau后期疗效标准。结果:36例全部获得随访,随访时间1.6～3.6年,平均2.3年。末次随访肘关节功能按Mayo肘关节功能评分(MEPS)进行评定,功能评分优良率经皮撬拨复位克氏针固定组为82%,切开复位克氏针固定组为67%,弹性髓内钉间接固定组为88.6%。结论:三种方法均可用于JudetⅢ度和Ⅳ度桡骨颈骨折的治疗,其中弹性髓内钉间接固定方法效果更佳。

Background： Radial neck fracture is very common in children. It has been reported that closed reduction with joystick, open reduction with Kirschner wire, and elastic intramedullary nailing can be used for the treatment of Judet III and IV radial neck fractures in children. Objective： The aim of the study is to compare the clinical outcomes of the three methods in treatment of Judet III and IV radial neck fractures in children. Methods： From March 2006 to December 2009, 36 children with Judet III（n=27） and IV （n=9） radial neck fractures underwent closed reduction with joystick （n=18）, open reduction and fixation with Kirschner wire （n=8）, and elastic intramedullary nailing （n=10）. There were 23 boys and 15 girls with a mean age of 11.2 years （range 8 to 15 years）. Results： All the children were followed up for 2.3 years （range 1.6 to 3.6 years）. According to Mayo elbow performance score, the rates of excellent and good results were 82%, 67% and 88.6% in joystick reduction, Kirschner wire reduction and elastic intrarnedullary nailing, respectively. Conclusions： Elastic intramedullary nailing is better than the other two methods in treatment of radial neck fractures in children .