弹性髓内钉治疗儿童桡骨颈骨折并发症及风险因素分析

Analysis of complications of the treatment of radial neck fracture using elastic intramedullary nail in children

目的总结弹性髓内钉治疗儿童桡骨颈骨折的并发症,探讨并发症发生的风险因素。方法回顾分析2014年1月至2019年12月,我院使用弹性髓内钉治疗,且随访时间≥6个月的149例桡骨颈骨折患儿。年龄2岁1个月至15岁,平均8岁6个月。其中男78例,女71例。左侧82例,右侧67例。摔伤125例,低空坠落(<1.5米)14例,运动损伤4例,骑自行车摔伤3例,高空坠落(>1.5米)2例,交通事故1例。Chambers分型1型132例;2型17例。89例(59.7%)合并肘关节其它部位骨折。129例闭合复位,20例切开复位。观察伤口愈合情况、有无肘外翻畸形、肘关节和前臂以及手指活动,定期行肘关节正侧位X线检查观察移位程度、再移位、骨化性肌炎/异位骨化、骨折愈合情况、缺血性坏死、发育情况等。采用两组资料的均数比较、Fisher精确检验法对结果进行统计学处理,二元Logistic回归方法筛选出危险因素。结果随访时间6~29个月,平均8个月。31例(20.8%)发生并发症,骨化性肌炎/异位骨化是最常见的并发症。单因素分析发现移位程度(P=0.009)和切开复位(P=0.000)与并发症相关,性别(P=0.014)、年龄(P=0.05)、移位程度(P=0.005)和切开复位(P=0.000)与骨化性肌炎相关。多因素分析发现只有切开复位是并发症(P=0.001)和骨化性肌炎(P=0.020)的独立危险因素。结论弹性髓内钉治疗儿童桡骨颈骨折最常见的并发症为骨化性肌炎/异位骨化,只有切开复位是并发症及骨化性肌炎的危险因素。

Objective To summarize the complications of elastic intramedullary nails for the treatment of children’s radial neck fractures,and to explore the risk factors of complications.Methods A total of 149 radial neck fracture children(78 boys and 71 girls)treated with elastic intramedullary nails were retrospectively analyzed from January 2014 to December 2019.The follow-up was≥6 months.The average age was 8 years and 6 months(range:2 years and 1 month to 15 years).There were 82 cases on the left side and 67 cases on the right side;125 cases of falls,14 cases of falls from low altitude(less than 1.5 meters);4 cases of sports injuries,3 cases of injuries from cycling,2 cases of falls from heights(higher than 1.5 meters);1 case of traffic accident;132 cases of type 1;17 cases of type 2;89 cases(59.7%)had fractures of other parts of the elbow joint;129 cases were closed reduction and 20 cases were open reduction.Wound,elbow deformity,unctions of the elbow and forearm and hand,abmornal X-ray images and so on were observed.The results were statistically processed by the independent-samples T test and Fisher test.The binary logistic regression analysis was used to screen out independent risk factors.Results The follow-up was 6-29 months,with an average of 8 months.Complications occurred in 31 cases(20.8%).Myositis ossificans/heterotopic ossification was the most common.Univariate analysis found that the degree of displacement(P=0.009)and open reduction(P=0.000)were associated with complications.Sex(P=0.014),age(P=0.05),degree of displacement(P=0.005),and open reduction(P=0.000)were associated with ossified myositis.Multifactorial found that only open reduction was an independent risk factor for complications(P=0.001)and ossified myositis(P=0.020).Conclusions The most common complication of elastic intramedullary nails for children with radial neck fracture is myositis ossificans/heterotopic bone change.Open reduction was the only independent risk factor for complications and ossified myositis.