折顶手法复位夹板外固定与手法闭合复位克氏针联合弹性髓内钉内固定治疗儿童尺桡骨远端双骨折的比较研究

A comparative study of angulation-opposition manipulative reduction and external fixation with splint versus closed manipulative reduction and internal fixation with Kirschner-wires and elastic intramedullary nail for treatment of double fractures of distal ulna and radius in children

目的:比较折顶手法复位夹板外固定与手法闭合复位克氏针联合弹性髓内钉内固定治疗儿童尺桡骨远端双骨折的临床疗效。方法:将192例尺桡骨远端双骨折患儿随机分为2组,每组96例,分别采用折顶手法复位夹板外固定(外固定组)与手法闭合复位克氏针联合弹性髓内钉内固定(内固定组)治疗。记录并比较2组患儿的骨折愈合时间,末次随访时采用Anderson前臂骨折疗效评价标准评价临床疗效。结果:所有患儿均获随访,随访时间3~4个月,中位数3.5个月。外固定组骨折愈合时间(30.40±2.10)d,内固定组骨折愈合时间(31.92±2.25)d;2组患儿骨折愈合时间比较,差异无统计学意义(t=0.824,P=0.172)。末次随访时,外固定组临床疗效优83例、良10例、可3例,内固定组临床疗效优90例、良5例、可1例,2组患儿临床疗效比较,差异无统计学意义(Z=-1.698,P=0.089)。结论:折顶手法复位夹板外固定与手法闭合复位克氏针联合弹性髓内钉内固定治疗儿童尺桡骨远端双骨折,均有助于骨折早期愈合,且两者的临床疗效相当。

Objective:To compare the clinical outcomes of angulation-opposition manipulative reduction and external fixation with splint versus closed manipulative reduction and internal fixation with Kirschner-wires(K-wires)and elastic intramedullary nail in treatment of double fractures of distal ulna and radius in children.Methods:One hundred and ninety-two children with double fractures of distal ulna and radius were enrolled in the study and were randomly divided into external fixation group and internal fixation group,96 cases in each group.The children in external fixation group were treated with angulation-opposition manipulative reduction and external fixation with splint,while the ones in internal fixation group with closed manipulative reduction and internal fixation with K-wires and elastic intramedullary nail.The fracture healing time was recorded and compared between the 2 groups,and the clinical outcomes were evaluated according to Anderson therapeutic effect evaluation standard of forearm fracture at the last follow-up.Results:All children in the 2 groups were followed up for 3-4 months with a median of 3.5 months.The fracture healing time was 30.40±2.10 days in external fixation group and 31.92±2.25 days in internal fixation group.There was no statistical difference in fracture healing time between the 2 groups(t=0.824,P=0.172).At the last follow-up,83 children obtained an excellent result,10 good and 3 fair in external fixation group;while 90 children obtained an excellent result,5 good and 1 fair in internal fixation group.There was no statistical differences in the clinical outcomes between the 2 groups(Z=-1.698,P=0.089).Conclusion:The angulation-opposition manipulative reduction and external fixation with splint is similar to closed manipulative reduction and internal fixation with K-wires and elastic intramedullary nail in the clinical outcomes in treatment of double fractures of distal ulna and radius in children,and the both are beneficial to early fracture healing.