经皮撬拨复位内固定治疗军队训练伤桡骨颈骨折

Percutaneous poking reduction for treatment of radial neck fracture sustained in military training

目的探讨经皮撬拨复位内固定治疗军队训练伤桡骨颈骨折的临床疗效。方法自2005年9月至2017年3月,我院骨科共收治桡骨颈骨折311例,其中男性265例,女性46例;年龄18～33(25. 3±6. 2)岁。受伤原因:摔伤229例;高处坠落伤41例;拳击伤41例。骨折均为单纯性桡骨颈骨折,根据O’Brien骨折分型:Ⅰ型138例:Ⅱ型152例;Ⅲ型21例。所有患者分为撬拨组和对照组,其中撬拨组232例,采用透视下经皮克氏针撬拨复位内固定术;对照组79例,采用切开复位微型钢板内固定术。记录骨折愈合时间和肘关节JOA功能评分。结果末次随访时撬拨组的JOA评分(96. 0±3. 0)分,对照组的JOA评分(90. 2±4. 4)分,两组间比较差异有统计学意义(t=13. 878,P <0. 01)。所有骨折均获得Ⅰ期愈合,撬拨组的骨折愈合时间4～6 (5. 1±0. 5)周,对照组的骨折愈合时间12～22(17. 5±4. 0)周,两组间比较差异有统计学意义(t=18. 008,P <0. 01)。结论经皮撬拨复位内固定治疗军队训练伤性桡骨颈骨折,具有微创、快速康复、功能满意的优点。

Objective To assess the efficacy of percutaneous poking reduction for treatment of radial neck fractures sustained during military training.Methods From September,2005to March,2017,a total of 311 patients with radial neck fractures were treated in our hospital,including 265 male and 46 female patients with a mean age of 25.3±6.2years (range 18-33years).The patients sustained the injuries due to tumbling (n =229)or failing from height (n =41)or during boxing (n =41).According to O'Brien classification,the fractures were classified into type Ⅰ (138cases),type Ⅱ(152cases )and type Ⅲ (21cases).The patients received percutaneous poking reduction with pin fixation (232patients)or open reduction and plate fixation (79patients),and the bone healing time and the Japanese Orthopedic Association (JOA)function scores of the elbow were compared between the 2groups.Results The JOA scores of the elbow differed significantly between the poking reduction group and the open reduction group (96.0±3.0vs 90.2±4.4,t =13.878,P <0.01).The time of bone healing in the poking reduction group was 5.1±0.5 weeks (range 4-6weeks),significantly shorter than that in the open reduction group (17.5±4.0weeks, range 12-22weeks ;t =18.008,P <0.01).Conclusion Percutaneous poking reduction is minimally invasive for treatment of radial neck fracture and better promotes rapid rehabilitation and functional recovery compared with open reduction.