造影下克氏针撬拨复位弹性髓内钉固定治疗低龄儿童JudetⅣ型桡骨颈骨折效果观察

Treatment of JudetⅣtype radial neck fracture in young children with Kirschner wire percutaneous leverage reduction and elastic intramedullary nail fixation under elbow arthrography

目的探讨肘关节造影下经皮克氏针撬拨复位后弹性髓内钉内固定方法在低龄儿童JudetⅣ型桡骨颈骨折治疗中的应用。方法选取安徽省儿童医院骨科2017年9月—2020年9月收治的骨折患儿29例,其中男11例,女18例,年龄3岁3个月~6岁11个月,均为外伤后1周内儿童JudetⅣ型桡骨颈骨折。均住院后在全麻下进行手术,选用碘海醇造影剂1 mL,混合生理盐水按照1∶1比例,肘后方间隙注入肘关节,C臂透视下可见原不显影的骨折断端软骨及骨骺,经皮克氏针撬拨骨折断端复位,自桡骨远端逆行穿入弹性髓内钉固定骨折断端,术后肘关节功能位石膏固定4周。结果本组29例患儿按Metaizeau的整复标准,其中优24例,良3例,可2例。本组29例患儿在门诊获得6~36个月的随访,参照Metaizeau疗效标准进行临床功能评定,优26例,良2例,可1例。本组患儿治疗优良率为96.5%,术后随访摄片未发现骨折再移位、桡骨小头坏死吸收等,所有患儿无骨折不愈合、骨化性肌炎、桡神经损伤、肘关节功能障碍等并发症。结论肘关节造影在低龄儿童JudetⅣ型桡骨颈骨折治疗中可清晰地显示原不显影的骨折断端软骨及骨骺。经皮克氏针撬拨复位创伤小,弹性髓内钉内固定骨折牢固,此方法尤其是对于治疗低龄儿童JudetⅣ型桡骨颈骨折效果好,远期关节功能恢复佳。

Objective To investigate the application of elastic intramedullary nail internal fixation after Kirschner wire(K-wire)percutaneous leverage reduction with elbow arthrography in the treatment of JudetⅣtype radial neck fracture in young children.Methods A total of 29 children(including 11 males and 18 females,aged 3 years and 3 months to 6 years and 11 months)in the Department of Orthopedics of Anhui Children’s Hospital from September 2017 to September 2020 were selected.All children suffered JudetⅣtype radial neck fracture within one week after trauma.All patients underwent surgery under general anaesthesia after hospitalisation.The contrast agent was 1 mL iohexol,mixed with normal saline in a ratio of 1∶1 and injected into the elbow joint in the posterior space of the elbow.C-arm fluoroscopy showed the cartilage and epiphysis at the broken end of the fracture,which had not been developed before.The broken end of the fracture was reduced by K-wire pry,and the fracture was fixed by retrograde penetration of elastic intramedullary nail from the distal end of the radius.The functional position of the elbow was fixed in plaster for four weeks after surgery.Results According to Metaizeau’s revision standard,24 cases were excellent,3 cases were good,and 2 cases were fair.The 29 children were followed up for 6-36 months in the outpatient department.According to Metaizeau’s curative effect standard,26 cases were excellent,2 cases were good,and 1 case was fair.The excellent and good rate was 96.5%.Postoperative follow-up radiographs showed no fracture redisplacement and necrotic absorption of the radial head.No complications such as fracture nonunion,myositis ossificans,radial nerve injury and elbow joint dysfunction were observed in all cases.Conclusion Elbow arthrography can clearly show the cartilage and epiphysis at the broken end of the fracture without development in the treatment of the JudetⅣtype of radial neck fracture in young children.The trauma of reduction by K-wire prying is small,and the internal fixation by elastic intramedullary nail is firm.This method is especially effective for the treatment of JudetⅣtype radial neck fracture in young children,and the long-term joint function recovery is good.