CAJ | 학술논문

目的介绍经皮克氏针撬拨和弹性髓内钉复位固定治疗O' Brien Ⅱ、Ⅲ度儿童桡骨颈骨折的疗效.方法 2006年6月至2010年8月共收治O' Brien Ⅱ、Ⅲ度的桡骨颈骨折17例,平均年龄9.7岁,其中男8例,女9例；左侧13例,右侧4例.手术距受伤时间平均4.6d.合并损伤情况,2例合并尺骨近端骨折,1例合并肱骨内上髁骨折,1例合并肘关节脱位.采用2.0mm克氏针尖头深入骨折缝隙中撬拨复位固定(PKWL),或采用经腕部穿入经预弯的2.0mm弹性髓内钉(德国Thalon)达头下,然后旋转钉体带动桡骨头复位(CIMP).对O' Brien Ⅲ度骨折需两种方法配合才能复位.术后长臂石膏托固定于上肢功能位3周.之后功能锻炼.结果 17例患儿中,16例采用桡骨颈闭合复位,1例合并肘关节后脱位因完全移位,予切开复位克氏针内固定治疗.闭合复位的病例中有4例采用PKWL法复位固定,12例采用CIMP法治疗.2例合并尺骨近端骨折,1例采取保守治疗,另1例采取切开复位张力带钢丝内固定；1例合并肱骨内上髁骨折亦采用切开复位,空心螺钉内固定.17例均获随访.平均随访时间8.6个月.所有病例骨折均愈合,平均愈合时间4.2周.根据Tibone和Stoltz功能评价标准,优12例,良4例,可1例.1例并发腕部钉尾皮下滑囊形成.无其他并发症发生.结论倾斜移位的儿童桡骨颈骨折可通过PKWL或CIMP整复和固定,对严重倾斜移位者则需要两者配合使用,PKWL的复位能力似乎更为全面.
목적 개소경피극씨침효발화탄성수내정복위고정치료O' Brien Ⅱ、Ⅲ도인동뇨골경골절적료효.방법 2006년6월지2010년8월공수치O' Brien Ⅱ、Ⅲ도적뇨골경골절17례,평균년령9.7세,기중남8례,녀9례；좌측13례,우측4례.수술거수상시간평균4.6d.합병손상정황,2례합병척골근단골절,1례합병굉골내상과골절,1례합병주관절탈위.채용2.0mm극씨침첨두심입골절봉극중효발복위고정(PKWL),혹채용경완부천입경예만적2.0mm탄성수내정(덕국Thalon)체두하,연후선전정체대동뇨골두복위(CIMP).대O' Brien Ⅲ도골절수량충방법배합재능복위.술후장비석고탁고정우상지공능위3주.지후공능단련.결과 17례환인중,16례채용뇨골경폐합복위,1례합병주관절후탈위인완전이위,여절개복위극씨침내고정치료.폐합복위적병례중유4례채용PKWL법복위고정,12례채용CIMP법치료.2례합병척골근단골절,1례채취보수치료,령1례채취절개복위장력대강사내고정；1례합병굉골내상과골절역채용절개복위,공심라정내고정.17례균획수방.평균수방시간8.6개월.소유병례골절균유합,평균유합시간4.2주.근거Tibone화Stoltz공능평개표준,우12례,량4례,가1례.1례병발완부정미피하활낭형성.무기타병발증발생.결론 경사이위적인동뇨골경골절가통과PKWL혹CIMP정복화고정,대엄중경사이위자칙수요량자배합사용,PKWL적복위능력사호경위전면.
Objective To summarize the results of treatment of radial neck fractures of O'Brien type Ⅱ and Ⅲ in children by close intramedullary pinning (CIMP) and percutaneous Kirshner's wire leverage (PKWL).Methods From Jun.2006 to Aug.2010,17 cases of radial neck fractures of O'Brien type Ⅱ and Ⅲ in children were treated.Among them,8 were male and 9 were female,with a mean age of 9.7 years.There were 13 left arms and 4 right arms.The interval between the injury and surgery averaged 4.6 days.Concomitant injuries included proximal ulna fractures in 2 cases,medial epicondyle fracture of humerus in one case,elbow dislocation in another.PKWL and CIMP were conducted individually or in combination to effect fracture reduction.3 weeks of long-arm cast followed by functional exercises were carried out as follow-on treatment.Results Of the 17 cases,16 had close reduction (4 by PKWL and 12 by CIMP).The remaining one who had a completely displaced fracture resulted from dislocation was openly reduced and fixed with K-wires.Of the two concomitant proximal ulna fracture,one was treated conservatively and the other was openly reduced and internally fixed.This was the same for displaced medial epicondyle of the humerus.All of the cases were followed-up for a mean of 8.6 months.All fractures healed in a mean of 4.2 weeks.According to Tibone and Stoltz function scale,12 were excellent,4 were good and one fair.No other complication took place except for a nail end irritation resulting in a bursa.Conclusions Both PKWL and CIMP can independently reduce the fractures.In case of severely tilted and displaced fractures,both of these two methods will be required.PKWL seems to be able to achieve better reduction.