儿童桡骨颈骨折两种内固定方法的疗效比较

Treatment of radial neck fractures in children with elastic intramedullary nailing versus Kirschner wire

[目的]比较采用弹性髓内钉固定术与克氏针固定术治疗OBrienⅡ、Ⅲ型儿童桡骨颈骨折的临床效果。[方法]回顾性分析本科2012年1月~2016年1月收治的35例OBrienⅡ、Ⅲ型儿童桡骨颈骨折患儿的临床资料,男22例,女13例,年龄6.8~16岁,平均11.6岁,均为闭合性损伤,术前均无桡神经损伤和肘部其他骨折脱位表现。根据不同的内固定方法将患儿分成弹性髓内钉固定组16例和克氏针固定组19例,两组患儿在性别、年龄、病程以及骨折分型等一般资料上差异无统计学意义(P>0.05)。比较术后早期并发症、骨折愈合时间、桡骨头骨骺早闭、骨折复位效果及肘关节功能恢复情况。[结果]两组患儿术后各出现桡神经麻痹1例,3个月内自然完全恢复。术后均为无切口感染、针尾或钉尾刺激等并发症。随访6~20个月,平均11.5个月,术后3个月骨折均骨性愈合。根据Metaizeau骨折复位评定标准,克氏针固定组骨折复位优良率(73.68%)和弹性髓内钉固定组骨折复位优良率(81.25%)之间差异无统计学意义(P>0.05);根据Metaizeau肘关节功能评定标准,弹性髓内钉固定组肘关节功能优良率(93.75%)高于克氏针固定组(63.15%),差异有统计学意义(P<0.05)。[结论]OBrienⅡ、Ⅲ型儿童桡骨颈骨折手术时使用弹性髓内钉固定或克氏针固定均可达到满意的骨折复位与愈合。使用弹性髓内钉固定有利于肘关节早期功能锻炼,且术后肘关节功能恢复较好。

[Objective] To compare the clinical outcomes of O＇ Brien type Ⅱ and Ⅲ radial neck fractures treated with elastic intramedullary nailing versus Kirschner wire fixation in children. [Methods] Thirty-five children with O＇ Brien type Ⅱ and Ⅲ radial neck fractures, including 22 boys and 13 girls, aged from 6.8 years to 16 years with a mean of 11.6 years, received surgical treatment from January 2012 to January 2016. All children had closed injury without radial nerve injury or oth- er fracture/dislocation of the elbow. According to the method of internal fixation, the children were divided into the elastic intra- medullary nail group （n=16 cases） and the Kirschner wire group （n=19 cases） . There were no statistically significant differ- ences in gender, age, time elapsed from trauma to surgery, as well as fracture classification between the two groups （P 〉 0.05） . The early complications, fracture healing time, whether or not early closure of radial head epiphysis, fracture reduc- tion and elbow joint function were compared after operation. [Results] Radial nerve palsy was noted in 2 children after opera- tion, one case in each group, which got complete recover）, spontaneously in 3 months. No other complications, such as inci- sion infection, wire or nail tail irritation occurred in any child of the two groups. All of the children were followed up for 6 to 24 months with an average of 11.5 months. The fracture achieved solid healing at 3 months after operation in all of the patients, and early closure of radial head epiphysis was noted only in one child of the Kirschner wire group. According to Metaizeau＇ s criteria for the fracture reduction, the excellent and good rate was not significantly different between the two groups （81.25% vs 73.68%, P 〉 0.05）. However, the elastic intramedullary nail group was statistically superior to the Kirsehner wire groupbased on Metaizeau＇ s criteria for elbow function （93.75% vs 63.15%, P〈0.05） . [Conclusion] In the treatment of O＇ Brien type Ⅱ and Ⅲ radial neck fractures in chil- dren, both elastic intramedullary nail and Kirschner wirefixation would get satisfactory fracture reduction and healing. However, elastic intramedullary nail fixation facilitates early func- tional exercises to achieve better functional recovery of the elbow joint.