超声辅助下闭合复位治疗儿童桡骨远端骨折的临床疗效

Clinical efficacy of ultrasound-guided closed reduction for pediatric distal radius fracture

目的比较超声辅助下与徒手闭合复位石膏外固定治疗儿童桡骨远端骨折的临床疗效。方法回顾性分析2018年4月至2019年8月华中科技大学同济医学院附属武汉儿童医院收治的118例桡骨远端骨折患儿的临床资料, 按照复位方式的不同分为2组:58例行徒手闭合复位(Ⅰ组), 60例行超声辅助复位(Ⅱ组)。采用t检验比较2组患儿一般资料、就诊时间、门诊费用、术后疼痛、随访时改良的Mayo腕关节评分;χ2检验比较初次复位成功率、复位次数、住院治疗率和并发症;Mann-Whitney U检验比较2组术后摄片次数。结果 2组患儿门诊费用、住院治疗率比较, 差异均无统计学意义(均P>0.05)。Ⅰ组和Ⅱ组患儿在就诊时间、初次复位成功率、再次复位率、术后多次摄片率方面相比[(166.2±54.8) min比(142.6±49.2) min, 72.4%(42/58例)比88.3%(53/60例), 27.6%比1.7%, 20.7%比1.7%], 差异均有统计学意义(均P<0.05)。104例患儿闭合复位成功, 复位成功率为88.1%, 其中Ⅰ组的复位成功率为86.2%, Ⅱ组的成功率为90.0%。骨折愈合时间34~56 d, 平均43 d。2组患儿骨折愈合时间和术后疼痛评分比较, 差异均无统计学意义(均P>0.05);Ⅰ组和Ⅱ组术后改良的Mayo腕关节评分比较[(97.3±4.1)分比(98.8±2.9)分], 差异有统计学意义(P<0.05)。Ⅰ组术后7例患儿出现骨折再移位(6例石膏固定1周内, 1例石膏固定2周内), 其中4例行住院治疗;Ⅱ组术后5例出现骨折再移位(均在石膏固定1周内), 其中2例行住院治疗, 2组比较差异无统计学意义(P>0.05)。结论超声辅助与徒手闭合复位石膏外固定治疗儿童桡骨远端骨折的方式均可获得确切疗效、低并发症和良好关节功能。超声辅助闭合复位具有提高初次复位成功率、减少摄片次数和缩短就诊时间的优势。

Objective To compare the clinical efficacy of ultrasound-guided closed reduction and bare-handed reduction on pediatric distal radius fractures.Methods Clinical data of 118 consecutive pediatric patients with distal radius fracture treated in the Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science&Technology from April 2018 to August 2019 were retrospectively analyzed.Patients treated with bare-handed reduction and ultrasound-guided closed reduction were respectively classified into groupⅠ(58 cases)and groupⅡ(60 cases).Baseline characteristics,treatment duration,out-patient treatment cost,postoperative pain and the modified Mayo wrist function score during the follow-up visits between groups were compared by the t test.The success rate of initial reduction,reduction times,hospitalization rate and complication between 2 groups were compared by the Chi-square test.The number of postoperative imaging scans between 2 groups was compared by the Mann-Whitney U test.Results There were no significant differences in out-patient treatment cost and hospitalization rate between 2 groups(all P>0.05).There were significant differences in the length of stay[(166.2±54.8)min vs.(142.6±49.2)min],success rate of initial reductions[72.4%(42/58 cases)vs.88.3%(53/60 cases)],incidence of repeated reductions(27.6%vs.1.7%)and the incidence of postoperative repeated imaging scans(20.7%vs.1.7%)between groupⅠand groupⅡ(all P<0.05).A total of 104 patients(88.1%)were successfully treated with closed reduction and followed up,with a rate of success reductions.Among them,success rate of closed reduction in groupⅠandⅡwere 86.2%and 90.0%,respectively.The mean time of fracture healing was 43(34-56)days.There were no significant differences in fracture healing time and pain score between 2 groups(all P>0.05).The modified Mayo wrist score was significantly lower in groupⅠthan that of groupⅡ[(97.3±4.1)points vs.(98.8±2.9)points,P<0.05].Seven patients in groupⅠsuffered fracture re-displacement,including 6 cases within 1 case week and 1 within 2 weeks,and 4 cases admitted to the surgical ward for further management.Five patients in groupⅡhad re-displacement within 1 week of plaster fixation,of which 2 cases admitted to the surgical ward for further management,which was comparable between groups(P>0.05).Conclusions Both ultrasound-guided closed reduction and bare-handed reduction are effective on the treatment of pediatric distal radius fractures,showing low incidence of complications and satisfactory functional results.Owing to its higher success rate of initial reduction,lower frequency of postoperative ra-diography and shorter length of stay,ultrasound-guided closed reduction should be recommended.