应用弹性髓内钉微创治疗儿童前臂双骨折

Minimally invasive treatment of double forearm fractures in children with elastic intramedullary nails

目的探讨应用弹性髓内钉治疗儿童前臂双骨折的临床疗效及手术技巧。方法自2014年3月至2017年7月我科应用钛制弹性髓内钉治疗儿童前臂双骨折12例。弹性髓内钉自桡骨远端、尺骨近端置入,超肘腕关节石膏固定4~6周,X线片示骨痂形成良好后拆除石膏进行功能锻炼,骨折愈合后取出弹性髓内钉。结果桡骨闭合复位7例、切开复位5例,尺骨闭合复位8例、切开复位4例,入钉点切口平均长度(1.17±0.17)cm,切开复位切口平均长度(1.54±0.29)cm,手术时间(1.71±0.63)h,手术平均出血量(12.92±7.53)ml。术后随访8~48个月,平均(23.58±11.42)个月,3~8周骨折愈合,平均愈合时间(4.92±1.38)周,前臂旋前(83.75±6.44)°,旋后(85.83±5.15)°,肘关节、腕关节屈伸活动与健侧相似。无骨折不愈合及畸形愈合,无骨骺损伤,无针尾激惹症状。1例患儿取出弹性钉后再骨折,经保守治疗后愈合。结论应用钛制髓内钉治疗儿童前臂双骨折可以达到疗效满意且微创的效果。

Pediatric Hand Surgery Minimally invasive treatment of double forearm fractures in children with elastic intramedullary nails Liu Wei, Yang Zhi, Ding Xiaofei, Hu Feng, Huang Linke, Zhao Jinmin Published 2019-04-10 Cite as Chin J Hand Surg, 2019,35(2): 97-100. DOI: 10.3760/cma.j.issn.1005-054X.2019.02.006 Abstract Objective To investigate the clinical efficacy and surgical techniques of elastic intramedullary nail in the treatment of double forearm fractures in children. Methods From March 2014 to July 2017, 12 children with double forearm fractures were treated with titanium elastic intramedullary nails. The elastic intramedullary nails were inserted from the distal radius and proximal ulna, and the affected limb was fixed with plaster over elbow and wrist for 4 to 6 weeks. When X-ray showed that the callus was well formed, the plaster was removed for functional exercise. The elastic intramedullary nails were removed after fracture healing. Results The closed reduction of radius and ulnar was performed in 7 and 8 cases respectively. The open reduction of radius and ulnar was performed in 5 and 4 cases respectively. The average length of incision at nail entry point was (1.17±0.17) cm. The average length of incision for open reduction was (1.54±0.29) cm. The operation time was (1.71±0.63) hours. The average amount of bleeding during operation was (12.92±7.53) ml. The postoperative follow-up period was 8 to 48 months, with an average of (23.58±11.42) months. The duration of bone healing was 3 to 8 weeks with an average of (4.92±1.38) weeks. The pronation angle of forearm was (83.75±6.44)°, and the supination angle was (85.83±5.15)°. The flexion and extension activities of elbow and wrist joints were similar to those of the healthy side. No complications such as nonunion, malunion, epiphyseal injury and needle tail irritation symptoms occurred in all the cases. Conclusion The application of titanium intramedullary nail is effective and minimally invasive in the treatment of double forearm fractures in children.