撬拨复位与有限切开复位治疗难复型儿童前臂骨折的疗效比较

Comparison of pry reduction and limited open reduction in the treatment of refractory forearm fracture in children

目的分析对照撬拨复位与有限切开复位治疗难复型儿童前臂骨折的疗效比较。方法回顾分析我院2018年3月至2022年12月符合条件的68例难复型儿童前臂骨折患儿的临床资料,其中38例采用有限切开复位弹性髓内钉内固定治疗(有限切开复位组),30例采用克氏针撬拨复位弹性髓内钉内固定治疗(撬拨复位组),术后随访6~15个月,对比组间手术时间、术中出血量、骨折部位切口长度、进针点切口长度、骨折愈合时间等,术后6个月拆除弹性髓内钉后,通过Anderson功能评定标准进行疗效评价患肢功能及前臂旋转功能。结果两组患儿术后伤口均一期愈合,未出现骨折不愈合、伤口感染等并发症;撬拨复位组手术出血量(7.25±2.92)ml、骨折部位切口长度(0.50±0.18)cm和骨折愈合时间(6.79±0.78)周均少于有限切开组(19.76±7.15)ml、(3.74±0.56)cm、(9.81±0.93)周,差异均有统计学意义(P<0.05);两组手术时间及术后6个月前臂旋转功能、疗效对比差异无统计学意义(P>0.05)。结论对于难复型儿童前臂骨折,采用撬拨复位与有限切开复位术后患肢功能均恢复,但撬拨复位造成的创伤小,患肢术后外观较好,家属满意度高,值得进一步推广。

Objective To compare the efficacy of controlled prying reduction and limited open reduction in the treatment of refractory forearm fracture in children.Methods A total of 68 eligible children with refractory forearm fracture in our hospital from March 2018 to December 2022 were included,among them 38 were treated with limited open reduction elastic intramedullary nail-internal fixation(limited open reduction group),and 30 were treated with Kirkner pin pry reduction elastic intramedullary nail-internal fixation(pry reduction group).Postoperative follow-up was conducted for 6-15 months.The operative time,intraoperative blood loss,incision length at the fracture site,incision length at the needle entry point,fracture healing time and so on were compared between the groups.After the elastic intramedullary nail removal 6 months after surgery,functions of the affected limb and forearm rotation were evaluated by Anderson function evaluation criteria.Results The wounds of both groups healed in one stage,and no complications such as fracture nonunion and wound infection occurred.The amount of surgical bleeding,the length of incision at the fracture site and the healing time of fracture in the prying reduction group were all less than those in the limited incision group,with statistical significance(P<0.05).There was no significant difference in operation time,incision length,forearm rotation function and efficacy 6 months after operation between the two groups(P>0.05).Conclusions For children with refractory forearm fracture,functions of the affected limb are recovered after prying reduction and limited open reduction.Prying reduction causes less trauma with good appearance of affected limb and patient satisfaction,which is worthy of further promotion.