顺行弹性髓内钉内固定治疗儿童桡骨远端干骺交界区骨折

Anterograde elastic intramedullary nail fixation for the treatment of distal radius diaphyseal metaphyseal junction fracture in children

目的探讨顺行弹性髓内钉内固定治疗儿童桡骨远端干骺交界区骨折(distal radius diaphyseal metaphyseal junction fracture, DRDMJ)的临床效果。方法自2019年1月至2022年12月我科采用顺行弹性髓内钉内固定治疗25例儿童DRDMJ, 所有病例均为闭合性损伤, 合并尺骨骨折21例。手术在C臂机透视下进行, 复位后将预弯的弹性髓内钉顺行插进髓腔固定骨折端, 复位失败行克氏针撬拨辅助复位。本组克氏针撬拨辅助复位9例, 同时行尺骨弹性髓内钉顺行固定18例。结果术后随访10~24个月, 平均15个月;愈合时间4~6周, 平均5.2周;无一例延迟愈合与畸形愈合, 无一例骨骺及神经损伤, 无一例钉尾激惹症状。采用Gartland-Werley评分标准评定疗效, 末次随访腕关节功能:优23例, 良2例;优良率100%。结论儿童DRDMJ复位固定困难, 采用闭合复位顺行髓内钉内固定治疗, 复位后弹性髓内钉符合桡骨的生理学特征, 具有创伤小、对骨骺生长干预少等优点, 是一个较为理想的方法。

Objective To explore the clinical efficacy of antegrade elastic intramedullary nail fixation in the treatment of distal radius diaphyseal metaphyseal junction fracture(DRDMJ)in children.Methods From January 2019 to December 2022,25 children with DRDMJ were treated with antegrade elastic intramedullary nail fixation.All cases were closed injuries and 21 cases were complicated with ulnar fractures.The surgery was performed under C-arm X-ray fluoroscopy.After reduction,pre bent elastic intramedullary nails were inserted into the medullary cavity to fix the fracture end.If the reduction failed,Kirschner wire prying and pulling were used to assist in reduction.In this group,9 cases were treated with Kirschner wire prying and pulling as auxiliary reduction,while 18 cases were treated with elastic intramedullary nail anterograde fixation of the ulna.Results The postoperative follow-up was 10 to 24 months,with an average of15 months.The healing time was 4 to 6 weeks,with an average of 5.2 weeks.There was no cases of delayed or abnormal healing,no cases of epiphyseal or nerve injury,and no cases of nail tail rritation symptoms.The Gartland-Werley scoring system was used to evaluate the efficacy.At last follow-up,the wrist joint function was excellent in 23 cases and good in 2 cases,with an excellent and good rate being 100%.Conclusion The DRDMJ in children has difficulty in reduction and fixation.Closed reduction and antegrade intramedullary nail fixation are used for treatment.After reduction,the elastic intramedullary nail conforms to the physiological characteristics of the radius and has the advantages of minimal trauma and minimal intervention on epiphyseal growth.It is an ideal method.