闭合复位与切开复位内固定治疗儿童桡骨颈骨折的对比研究

Comparative study of close reduction and open reduction and internal fixation in the treatment of radial neck fractures in children

目的比较关节造影下撬拨复位弹性钉内固定与切开复位克氏针内固定治疗儿童桡骨颈骨折的疗效。方法回顾性分析自2015年7月至2018年6月治疗的儿童O′BrienⅡ型和Ⅲ型桡骨颈骨折病例共41例。16例行切开复位克氏针内固定,术前骨折移位成角平均为(67±16)°(35°~90°);25例行关节造影下撬拨复位弹性钉内固定,术前骨折移位成角平均为(63±15)°(31°~88°)。以Metaizeau影像学评分评价骨折复位情况,以Steele评分评价肘关节屈伸、前臂旋转功能和提携角大小。结果术后随访时间为12~19个月。术后克氏针组骨折成角平均为(4±2)°(0°~7°),弹性钉组为(3±2)°(0°~8°)。末次随访时两组间患侧肘关节屈伸和前臂旋转活动范围差异无统计学意义(P>0.05);克氏针组双侧提携角差异有统计学意义(P<0.05),弹性钉组双侧提携角差异无统计学意义(P>0.05)。Metaizeau评分克氏针组87%(14例/16例)为优,13%(2例/16例)为良;弹性钉组84%(21例/25例)为优,16%(4例/25例)为良。Steele评分克氏针组81%(13例/16例)为优,13%(2例/16例)为良,6%(1例/16例)为中;弹性钉组88%(22例/25例)为优,12%(3例/25例)为良。结论关节造影可清晰显示肱桡关节软骨面情况,便于判断肘关节整体对位关系。关节造影监视下经皮克氏针撬拨复位结合弹性钉内固定是治疗儿童O′BrienⅡ型和Ⅲ型桡骨颈骨折的有效方法。

Objective To compare the clinical efficacy of percutaneous reduction with arthrography and fixation with elastic stable intramedullary nailing(ESIN)and open reduction with Kirschner wire fixation in the treatment of radial neck fractures in children.Methods A total of 41 cases of O′Brien typeⅡandⅢradial neck fractures in children treated from July 2015 to June 2018 were analyzed retrospectively.16 cases were treated with open reduction and Kirschner wire internal fixation.The average angle of fracture displacement before operation was(67±16)°(ranged,35°to 90°).25 cases were treated with percutaneous reduction with arthrography and ESIN fixation.The average angle of fracture displacement before operation was(63±15)°(ranged,31°to 88°).Metaizeau imaging score was used to evaluate fracture reduction.Steele criteria was used to evaluate the elbow flexion and extension,forearm rotation function and carrying angle.Results The period of follow-up was 12 to 19 months.The average angle of fractures after operation was(4±2)°(ranged,0°to 7°)in Kirschner wire group and(3±2)°(ranged,0°to 8°)in ESIN group.At the last follow-up,there was no significant difference in the range of elbow flexion and extension and forearm rotation between the two groups(P>0.05).The difference in carrying angle between injured side and healthy side of the Kirschner wire group was statistically significant(P<0.05),while that of the ESIN group was not(P>0.05).According to the Metaizeau criteria,the results were excellent in 87%cases(14/16)and good in 13%cases(2/16)in Kirschner group,while the results were excellent in 84%cases(21/25)and good in 16%cases(4/25)in ESIN group.According to the Steele criteria,the results were excellent in 81%cases(13/16),good in 13%cases(2/16),fair in 6%cases(1/16)in Kirschner wire group,while the results were excellent in 88%cases(22/25)and good in 12%cases(3/25)in ESIN group.Conclusion The arthrography can clearly show the cartilage surface of humeroradial joint,which is convenient to judge the overall alignment of elbow joint.The percutaneous Kirschner wire prying reduction combined with ESIN fixation under arthrography is an effective method for the treatment of O′Brien typeⅡandⅢradial neck fractures in children.