超声引导闭合复位外固定治疗儿童桡骨远端骨折

Ultrasound-guided closed reduction and external fixation for distal radius fractures in children

[目的]探讨超声引导下闭合复位改良微型外固定架治疗儿童桡骨远端不稳定性骨折的临床疗效。[方法] 2017年3月—2020年12月,55例儿童桡骨远端不稳定性骨折患者纳入本研究,根据根据医患沟通结果,29例采用超声引导下闭合复位改良微型外固定架治疗,26例采用透视下闭合复位传统外固定架治疗。比较两组患者的围手术期、随访和影像资料。[结果]两组患者均顺利完成手术。超声组的手术时间、影像曝光次数、术中失血量、住院时间显著优于透视组(P<0.05)。术后1、3 d时超声组的WB-FACES疼痛评分显著低于透视组(P<0.05)。两组患者平均随访(18.53±4.24)个月。两组患者拆除外固定时间和完全负重活动时间比较差异均无统计学意义(P>0.05)。与术后3个月相比,末次随访时两组的腕伸-屈ROM、腕尺偏-桡偏ROM均显著增加(P<0.05),两组的Gartland-Werlay评分均有所进步,但差异均无统计学意义(P>0.05)。相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,两组骨折复位质量比较差异无统计学意义(P>0.05)。两组术后PT、RI、RL均较术前显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。[结论]超声引导下闭合复位改良微型外固定架治疗儿童桡骨远端不稳定性骨折临床效果优于透视下闭合复位外固定架固定。

[Objective] To investigate the clinical effect of ultrasound-guided closed reduction and fixation with modified mini-external fixator for unstable distal radius fractures in children. [Methods] From March 2017 to December 2020, 55 children with unstable fractures of the distal radius were enrolled in this study. According to doctor-patient communication results, 29 patients were treated with ultrasound-guided closed reduction and fixation with modified mini-external fixator(the ultrasound group), while the remaining 26 children were treated with traditional external fixator under fluoroscopy(the fluoroscopy group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation performed smoothly. The ultrasound group proved significantly superior to the fluoroscopy group in terms of operation time, imaging exposure times, intraoperative blood loss and hospital stay(P<0.05). In addition, the WB-faces pain scores in the ultrasound group were significantly lower than those in the fluoroscopy group at1day and 3 days postoperatively(P<0.05). All patients in both groups were followed up for(18.53±4.24) months on average, with no significant differences in the time to remove external fixator and the time to resume full weight-bearing activity between the two groups(P>0.05).Compared with those 3 months after surgery, the extension-flexion range of motion(ROM) and ulnar-radial deviation ROM significantly increased in both groups(P<0.05), the Gartland-Werlay scores also improved in both groups at the last follow-up whereas without statistically significant differences(P>0.05). However, there were no significant differences in the abovesaid indexes between the two groups at any corresponding time points(P>0.05). Radiographically, there was no significant difference in fracture reduction quality between the two groups(P>0.05). The PT, RI and RL in both groups were significantly improved after operation(P<0.05), whereas no significant differences in the above imaging parameters were noticed between the two groups at corresponding time points(P>0.05). [Conclusion] The ultrasound-guided closed reduction and fixation with modified mini-external fixator does achieve considerably better clinical outcomes over the fluoroscopic closed reduction and conventional external fixator for distal radial unstable fractures in children.