预成型弹性髓内钉固定儿童桡骨远端干骺端骨折

Preformed elastic intramedullary nail fixation for distal radius diaphyseal metaphyseal junction fractures in children

[目的]探讨预成型弹性髓内钉(elastic stable intramedullary nail,ESIN)固定治疗儿童桡骨远端干骺端骨折(distal radius diaphyseal metaphyseal junction fracture,DRDMJ)的效果。[方法]回顾性分析2020年1月—2022年9月于本院就诊的80例DRDMJ患儿的临床资料。根据医患沟通结果,40例采用透视下改良三维重建指导预成型逆行ESIN固定术(预成型组),40例采用透视下逆行ESIN固定术(未成型组)。比较两组患者围术期、随访及影像资料。[结果]两组手术时间、切口长度、术中透视次数、术中出血量、切口愈合等级、主动活动时间以及住院时间的差异均无统计学意义(P>0.05)。随访时间平均(15.0±3.5)个月,两组完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组MEPS评分、Cooney腕评分均显著增加(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)。预成型组随访期间发生术后骨折二次移位发生率显著低于未成型组[例(%),4/40(10.0)vs 11/40(27.5),P=0.045]。影像方面,与术前相比,术后4周、末次随访时两组掌倾角(palmar tilt,PT)、尺偏角(radial inclination,RI)、桡骨茎突长度(radial length,RL)均显著增加(P<0.05)。术后4周、末次随访时预成型组PT[(8.9±2.4)°vs(7.6±2.1)°,P=0.012;(11.3±2.0)°vs(10.4±1.8)°,P=0.038]、RL[(7.6±2.1)mm vs(6.5±2.0)mm,P=0.019;(9.6±1.7)mm vs(8.8±1.8)mm,P=0.044]显著优于未成型组。[结论]预成型逆行ESIN固定术应用于儿童DRDMJ中,可改善术后骨折复位情况,对降低术后骨折二次移位发生率具有重要意义。

[Objective]To explore the clinical outcomes of preformed elastic intramedullary nail(ESIN)fixation for distal radius diaph-yseal metaphyseal junction fracture(DRDMJ)in children.[Methods]A retrospective analysis was conducted on 80 children who receivedsurgical treatment for DRDMJ in our hospital from January 2020 to September 2022.According to doctorpatient communication,40 casesunderwent retrograde ESIN preformed accoding to 3D CT reconstruction(the preformed group),while other 40 cases underwent conventional retrograde ESIN fixation(the non-preformed group).The documents regarding perioperative period,follow-up,and images were compared between two groups.[Results]There was no statistically significant difference in surgical time,incision length,intraoperative fluoros-copy frequency,intraoperative bleeding,incision healing grade,active activity time,and hospitalization time between the two groups(P>0.05).All children in both groups were followed up for(15.0±3.5)months in a mean,and there was no statistically significant difference intime to resume full weight-bearing activity between the two groups(P>0.05).The MEPS score and Cooney wrist score significantly in-creased in both groups(P<0.05)over time,which proved not statistically significant between the two groups at any time points accordingly(P>0.05).The preformed group had significantly lower incidence of postoperative fracture displacement during follow-up than the non-pre-formed group[4/40(10.0%)vs 11/40(27.5%),P=0.045].As for imaging,compared with those before surgery,the palmar tilt(PT),radial in-clination(RI),and radial length(RL)in both groups significantly increased 4 weeks postoperatively and at the last follow-up(P<0.05).At 4weeks after surgery and the last follow-up,the preformed group proved significantly superior to the non-preformed group in terms of PT[(8.9±2.4)°vs(7.6±2.1)°,P=0.012;(11.3±2.0)°vs(10.4±1.8)°,P=0.038]and RL[(7.6±2.1)mm vs(6.5±2.0)mm,P=0.019;(9.6±1.7)mm vs(8.8±1.8)mm,P=0.044].[Conclusion]The preformed retrograde ESIN fixation for pediatric DRDMJ does improve postoperative fracture reduction,and is of great significance in reducing the incidence of secondary fracture displacement.