闭合折顶整复手法结合夹板固定治疗儿童尺桡骨远端双骨折

Closed folding apex manipulation combined with splinting for the treatment of double fractures of distal ulna and radius in children

目的:探讨闭合折顶整复手法结合杉树皮外固定夹板治疗儿童尺桡骨远端双骨折的手法操作及其临床疗效。方法:自2017年1月至2019年12月,采用闭合折顶整复手法治疗儿童尺桡骨远端双骨折患者17例,男13例,女4例;年龄4~11(7.29±2.34)岁。整复后予以杉树皮夹板固定并随访6个月,根据末次随访复查的X线片评价骨折整复的对线对位,采用Anderson前臂功能评定标准评价患肢功能。结果:17例患儿中15例1次复位成功,2例再次复位成功,固定时间(25.00±3.35)d。随访6个月时,根据Anderson疗效评定标准,优12例,良3例,可2例,差0例。对位对线:所有病例对位>3/4,其中解剖复位10例,对线<10°者4例,对线<15°者3例。未出现骨折移位、不愈合、骨筋膜室综合征、前臂旋转功能障碍等并发症。结论:闭合折顶整复手法结合夹板固定手法复位儿童尺桡骨远端双骨折复位成功率高,并发症少,降低术者操作难度同时减轻患者痛苦。

Objective:To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children.Methods:From January 2017 to December 2019,17 children with double fractures of distal ulna and radius were treated with closed-folded apex consolidation maneuver,including 13 males and 4 females,aged from 4 to 11 years old with an average of(7.29±2.34)years old.The fractures were fixed with cedar bark splint and followed up for 6 months,and alignment of fracture was evaluated according to the latest X-rays by follow up,and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria.Results:Fifteen of 17 children were successfully reset immediately,and 2 children were successfully reset again.The average fixed time was(25.00±3.35)days.At 6 months of follow up,12 patients got excellent results,3 good,2 fair,and 0 poor according to Anderson forearm function evaluation criteria.The position of all children were larger than 3/4,and 10 children were received anatomical reduction,alignment of 4 children was less than 10°,3 children was less than 15°.No complications such as fracture displacement,nonunion,compartment syndrome,and forearm rotation dysfunction occurred.Conclusion:Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate,lower complications,which could reduce operating difficulty and pain of patients.