儿童前臂骨折术后尺骨延迟愈合或不愈合原因分析

Delayed union or nonunion of the ulna after intramedullary nailing for pediatric forearm fractures

目的：探讨弹性髓内钉治疗儿童前臂双骨折术后出现尺骨延迟愈合及不愈合的可能原因。方法：2005年2月至2010年2月，对弹性髓内钉治疗闭合性儿童前臂双骨折术后出现骨延迟愈合或不愈合5例患者进行回顾性分析，均为男性；年龄3-14岁，平均9．4岁；骨折均累及尺桡骨干中1／3，其中2例患者既往曾有相同部位骨折史。高能量损伤3例，摔伤2例。其中4例患者予行切开复位，1例行闭合复位。观察患者术后并发症，并采用Daruwalla及Price评定标准进行疗效评价。结果：5倒患者均获得随访，时间7～19个月，平均11．4个月。4例出现尺骨延迟愈合，1例出现不愈合。其中3例单纯取出内固定继续保守治疗，2例予更换固定方式继续治疗，所有骨折达到骨性愈合，未发生钉道感染或皮肤激惹等并发症。根据Daruwalla及Priee评定标准，优3例，良2例。结论：弹性髓内钉治疗儿童前臂双骨折是一种很好的方法，但是进行该手术时需严格遵循手术操作规范，把握适应证，同时需要根据具体病例情况，有选择地应用，避免术后出现骨折延迟愈合或不愈合。

To analyze the causes of delayed union or nonunion of the ulna after intramedullary nailing in pedi- atric forearm fractures. Methods： From February 2005 to February 2010,5 patients with forearm fractures who were treated with titanium elastic nailing（TEN） were identified to fulfill the criteria of having developed a delayed union or nonunion of the ulna. The causes of delayed union or nonunion were investigated according to mechanism of injury, fracture location, treatments methods and postoperative management. All patients were male and the age was 3 to 14 years old with an average of 9.4 years. All fractures were located on the mid-third part of forearm. Two cases had a re-fracture. Among them, 3 cases caused by high- energy injury and 2 cases by falling down. Open reduction were performed in 4 cases while the other one was treated with closed reduction. Four patients were immobilized in an above-elbow cast ,postoperatively. Results ：All patients were followed up from 7 to 19 months with an average of 11.4 months. There were 4 delayed union and 1 nonunion. Three patients healed af- ter the removal of the nail and avoidance of weight-bearing. Two patients healed by replacing another fixation. No patients had soft-tissue irritation or nail-entry-site infections.. The clinical effect was evaluated according to Daruwalla and Price scores with 3 excellent and 2 good of the results. Conehmions： Using titanium elastic nailing for the treatment of pediatric both-bone fore-arm fractures is a good method. However,strict indication selection should be followed to avoid delayed union or nonunion.