顺行弹性髓内钉与逆行克氏针治疗儿童桡骨远端干骺交界区骨折的疗效分析

A analysis of the effect of anterograde elastic intramedullary nail and retrograde Kirschner wire treatment for pediatric distal radius diaphyseal metaphyseal junction fracture

目的比较顺行弹性髓内钉和逆行克氏针两种桡骨内固定方式治疗儿童桡骨远端干骺交界区骨折的临床疗效。方法回顾分析2017年1月至2021年11月,我院收治的73例桡骨远端干骺交界区骨折患儿临床资料,其中男65例,女8例;年龄3~15岁,平均(10.2±2.3)岁。根据桡骨内固定方式不同分为髓内钉组(n=37)和克氏针组(n=36)。比较两组患儿手术时间、术中透视次数、闭合复位失败改行切开复位患儿比例(下文统称切开率)、石膏固定时间、并发症、术后3个月腕关节活动度,末次随访腕关节功能优良率(采用Garland-Werley评分)。结果两组患儿随访时间6~15个月,平均(10.6±2.3)个月。其中髓内钉组手术时间(63.9±30.1)min,与克氏针组(57.9±34.1)min比较差异无统计学意义(P=0.425)。髓内钉组术中透视次数为(19.5±4.6)次,明显少于克氏针组(24.0±9.7)次(P=0.014)。髓内钉组切开率(2.7%vs.16.67%)及石膏固定时间[(3.4±0.6)周vs.(5.8±1.1)周]均少于克氏针组,差异有统计学意义(P=0.043,P<0.001)。并发症发生率髓内钉组少于克氏针组。术后3个月腕关节活动度髓内钉组均大于克氏针组(P<0.05);末次随访时Garland-Werley腕关节功能评分优良率髓内钉组高于克氏针组,两组比较差异无统计学意义(P>0.05)。结论治疗儿童桡骨远端干骺交界区骨折时采用顺行弹性髓内钉固定桡骨具有不损伤骨骺、透视次数少、切开率低、石膏固定时间短和术后并发症少等特点,可作为治疗该特殊类型骨折的有效方法。

Objective To compare the clinical efficacy of anterograde elastic intramedullary nail and retrograde Kirschner wire in the treatment of pediatric distal radius diaphyseal metaphyseal junction fractures.Methods This retrospective analysis included clinical data of 73 patients with distal radial physeal fractures who were treated in our hospital from January 2017 to November 2021.Among them,there were 65 males and 8 females,with a mean age of(10.2±2.3)years(range:3-15 years).Based on the different methods of radial internal fixation,the patients were divided into two groups:the intramedullary nail group(n=37)and the Kirschner wire group(n=36).The surgical time,intraoperative fluoroscopy frequency,proportion of open reduction patients after failed closed reduction(open reduction rate),duration of plaster immobilization,complications,wrist joint mobility at 3 months after surgery,and the rate of excellent wrist joint function at the last follow-up(evaluated by the Garland-Werley scoring system)were compared between the two groups.Results The mean follow-up of both groups was(10.6±2.3)months(range:6-15 months).The surgery time of the intramedullary nail group was(63.9±30.1)mins,which was not significantly different from that of the Kirschner wire group(57.9±34.1 mins)(P=0.425).The intraoperative fluoroscopy frequency of the intramedullary nail group was(19.5±4.6),significantly less than that of the Kirschner wire group(24.0±9.7)(P=0.014).The open reduction rate and duration of plaster immobilization for the intramedullary nail group were 2.7%and(3.4±0.6)weeks,respectively,both of which were significantly lower than those for the Kirschner wire group(16.67%,5.8±1.1 weeks)respectively(P=0.043,P<0.001).The incidence of complications in the intramedullary nail group was lower than that in the Kirschner wire group.The wrist joint mobility 3 months after surgery was greater in the intramedullary nail group than in the Kirschner wire group(P<0.05),and the rate of excellent wrist joint function evaluated by the Garland-Werley Scoring System at the last follow-up was higher in the intramedullary nail group than in the Kirschner wire group,with no statistically significant difference between the two groups(P>0.05).Conclusions Anterograde elastic intramedullary nail fixation will not damage the epiphysis in the treatment of distal radial physeal fractures in children,with lower intraoperative fluoroscopy frequency,lower open reduction rate,shorter plaster immobilization,and fewer postoperative complications.It can be considered as an effective method for the treatment of this specific type of fracture.