Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,whi...Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.展开更多
目的探讨采用腕关节镜技术联合尺骨短缩术治疗桡骨远端骨折后畸形愈合的临床效果。方法 2013年9月至2015年9月我院收治桡骨远端骨折后畸形愈合病人67例,根据手术方法分为三组:联合治疗组,35例,采用腕关节镜技术联合尺骨短缩术治疗;尺骨...目的探讨采用腕关节镜技术联合尺骨短缩术治疗桡骨远端骨折后畸形愈合的临床效果。方法 2013年9月至2015年9月我院收治桡骨远端骨折后畸形愈合病人67例,根据手术方法分为三组:联合治疗组,35例,采用腕关节镜技术联合尺骨短缩术治疗;尺骨短缩组,21例,采用单一的尺骨短缩术进行治疗;腕关节镜组,11例,采用单一的腕关节镜技术清理关节腔治疗。比较各组治疗后的数字评价量表(numerical rating scale,NRS)疼痛评分和上肢、肩、手功能障碍(disabilities of the arm,shoulder and hand,DASH)腕关节评分。结果联合治疗组、尺骨短缩组治疗后的NRS疼痛评分分别为(1.32±0.52)分、(1.63±0.71)分,两组的腕关节DASH评分分别为(15.42±6.31)分、(18.03±7.64)分,均较术前明显改善,差异有统计学意义(P均<0.05);但腕关节镜组治疗后改善不明显。联合治疗组治疗后的NRS疼痛评分最低,腕关节镜组最高,三组间得分进行两两比较,差异均有统计学意义(均P<0.05)。联合治疗组、尺骨短缩组治疗后的腕关节DASH评分差异并无统计学意义,但均优于腕关节镜组,差异均有统计学意义(均P<0.05)。结论尺骨短缩术联合腕关节镜技术对于桡骨远端骨折后畸形愈合造成的疼痛及功能障碍的改善具有积极的临床意义。展开更多
文摘Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.
文摘目的探讨采用腕关节镜技术联合尺骨短缩术治疗桡骨远端骨折后畸形愈合的临床效果。方法 2013年9月至2015年9月我院收治桡骨远端骨折后畸形愈合病人67例,根据手术方法分为三组:联合治疗组,35例,采用腕关节镜技术联合尺骨短缩术治疗;尺骨短缩组,21例,采用单一的尺骨短缩术进行治疗;腕关节镜组,11例,采用单一的腕关节镜技术清理关节腔治疗。比较各组治疗后的数字评价量表(numerical rating scale,NRS)疼痛评分和上肢、肩、手功能障碍(disabilities of the arm,shoulder and hand,DASH)腕关节评分。结果联合治疗组、尺骨短缩组治疗后的NRS疼痛评分分别为(1.32±0.52)分、(1.63±0.71)分,两组的腕关节DASH评分分别为(15.42±6.31)分、(18.03±7.64)分,均较术前明显改善,差异有统计学意义(P均<0.05);但腕关节镜组治疗后改善不明显。联合治疗组治疗后的NRS疼痛评分最低,腕关节镜组最高,三组间得分进行两两比较,差异均有统计学意义(均P<0.05)。联合治疗组、尺骨短缩组治疗后的腕关节DASH评分差异并无统计学意义,但均优于腕关节镜组,差异均有统计学意义(均P<0.05)。结论尺骨短缩术联合腕关节镜技术对于桡骨远端骨折后畸形愈合造成的疼痛及功能障碍的改善具有积极的临床意义。
