CAJ | 학술논문

目的总结诊治12例儿童舟骨骨折的经验,为早期、正确地治疗儿童舟骨骨折提供参考和依据.方法 1999年1月～2006年12月间诊治12例儿童舟骨骨折,男9例,女3例,年龄10～15岁,平均12.5岁;右侧10例,左侧2例.根据改良Herbert舟骨骨折分型,12例患儿中A1型1例,A2型3例,B1型1例,B2型2例,B3型1例,D1型3例,D2型1例.4例新鲜稳定型骨折、2例新鲜不稳定骨折以及2例D1型骨折予以石膏外同定治疗;1例骨折块移位>1mm的B2型骨折闭合复位失败后予以切开复位内固定术;1例B3型及1例D1型骨折分别行经皮DTJ空心螺钉内同定术;1例D2型骨折行切开复位、克氏针、螺钉内固定、游离髂骨移植术.结果石膏外同定治疗的8例患儿均于术后平均7.2周获得了临床骨愈合,术后所有患儿均无腕痛,患手握力平均恢复至健侧的91%,患侧腕关节屈伸活动度平均恢复至健侧的93%.经手术治疗的4例患儿于术后平均7.8周(B2型5周,B3型5.5周,D1型7周,D2型12周)获得了骨愈合,除1例D2型有轻度腕痛外其余3例均无腕关节症状,术后患手握力恢复至健侧的平均90%,患侧腕关节屈伸活动度恢复至健侧的平均91%.所有手术患儿切口均Ⅰ期愈合,无感染等并发症的发生.结论儿童舟骨骨折临床及X线表现相对较隐匿,早期正确的诊断和确切的外固定是预防骨折不愈合和骨不连的关键,植骨+内固定是舟骨骨不连的有效治疗手段.
목적 총결진치12례인동주골골절적경험,위조기、정학지치료인동주골골절제공삼고화의거.방법 1999년1월～2006년12월간진치12례인동주골골절,남9례,녀3례,년령10～15세,평균12.5세;우측10례,좌측2례.근거개량Herbert주골골절분형,12례환인중A1형1례,A2형3례,B1형1례,B2형2례,B3형1례,D1형3례,D2형1례.4례신선은정형골절、2례신선불은정골절이급2례D1형골절여이석고외동정치료;1례골절괴이위>1mm적B2형골절폐합복위실패후여이절개복위내고정술;1례B3형급1례D1형골절분별행경피DTJ공심라정내동정술;1례D2형골절행절개복위、극씨침、라정내고정、유리가골이식술.결과 석고외동정치료적8례환인균우술후평균7.2주획득료림상골유합,술후소유환인균무완통,환수악력평균회복지건측적91%,환측완관절굴신활동도평균회복지건측적93%.경수술치료적4례환인우술후평균7.8주(B2형5주,B3형5.5주,D1형7주,D2형12주)획득료골유합,제1례D2형유경도완통외기여3례균무완관절증상,술후환수악력회복지건측적평균90%,환측완관절굴신활동도회복지건측적평균91%.소유수술환인절구균Ⅰ기유합,무감염등병발증적발생.결론 인동주골골절림상급X선표현상대교은닉,조기정학적진단화학절적외고정시예방골절불유합화골불련적관건,식골+내고정시주골골불련적유효치료수단.
Objective To summarize the experience of diagnosis and treatment of scaphoid fractures in children, and provide a reliable and predictable program for the pediatric scaphoid fractures. Methods Twelve children with scaphoid fractures were treated conservatively or surgically, involving 9 boys and 3 girls with an average age of 12. 5 years (ranged from 10 to 15 years). Among them, 1 case was identified as type A1, 3 as A2, 1 as B2, 2 as B2, 1 as B3, 3 as D1 and 1 as D2, according to the modified Hetbert classification system. Four patients with acute stable fracture, 2 with acute unstable fracture and 2 with type D1 fracture were treated conservatively with cast immobilization, whereas a patients with type B2 fracture with displacement more than 1mm, one with type B3 and another one with type D2 were treated surgically with open reduction and internal fixation, percutaneous DTJ cannulated screw fixation, and screw fixation with bone grafting, respectively. Results All the patients treated with cast immobilization achieved bone union at mean 7. 2 weeks (range, 6 to 9 weeks) and pain relief was obtained in all eases with the grip strength to 91% (rang, 86% to 96%) and rang of motion (ROM) recovered to 93% (rang, 87% to 100%), both of which were compared with the healthy side, The other 4 cases treated surgically achieved bone union at mean 7. 8 weeks (5 weeks for type B2, 5. 5 weeks for type B3, 7 weeks for type D1, and 12 weeks for type D2) postoperatively and pain relief was obtained in all cases except for one mild wrist pain. The grip strength and ROM recovered to 90% (rang, 84% to 94%) and 91% (rang, 83% to 97%) respectively, compared with the healthy side. No postoperative complications occurred. Conclusions Clinical and radiological presentations are subtle in pediatric scaphoid fractures, early precise diagnosis and accurate cast immobilization play an important role in prevention of nonunion. Screw fixation with bone graft is an efficient alternative to treat nonunion of pediatric scaphoid fracture.