CAJ | 학술논문

目的：比较手法复位外固定与切开复位内固定小儿前臂闭合骨折的临床疗效。方法回顾分析216例小儿前臂闭合骨折患者的病例资料,其中167例通过手法复位外固定,49例行切开复位内固定。评估两种方法的治疗效果及并发症。结果所有患者均获随访,时间3~24个月。骨折愈合时间：手法复位外固定组为4~11(6．4±1．2)周,切开复位内固定组为6~15(8．5±1．9)周,差异有统计学意义(P <0．05)。根据疼痛和旋转角度丧失评定疗效,手法复位外固定组优良率94．0%,切开复位内固定组优良率93．9%,两组优良率比较差异无统计学意义(P >0．05)。手法复位外固定组中,133例≤10岁的患者中 7例出现前臂旋转功能障碍,34例>10岁的患者中有 6例出现功能障碍；未出现骨筋膜间室综合征等并发症。切开复位内固定组中,38例>10岁的患者中1例术后24h 内出现骨筋膜间室综合征,1例出现骨折延迟愈合,11例≤10岁的患者中1例出现再骨折；未出现内固定术后感染等并发症。两组并发症比较差异有统计学意义(P <0．05)。结论对于小儿前臂闭合骨折,因≤10岁的患者骨膜较厚,有较强的塑形能力,建议以手法复位石膏外固定治疗为主；而对于>10岁或经手法复位石膏外固定不能维持骨折断端稳定的患者,可行手术内固定治疗。
목적：비교수법복위외고정여절개복위내고정소인전비폐합골절적림상료효。방법회고분석216례소인전비폐합골절환자적병례자료,기중167례통과수법복위외고정,49례행절개복위내고정。평고량충방법적치료효과급병발증。결과소유환자균획수방,시간3~24개월。골절유합시간：수법복위외고정조위4~11(6．4±1．2)주,절개복위내고정조위6~15(8．5±1．9)주,차이유통계학의의(P <0．05)。근거동통화선전각도상실평정료효,수법복위외고정조우량솔94．0%,절개복위내고정조우량솔93．9%,량조우량솔비교차이무통계학의의(P >0．05)。수법복위외고정조중,133례≤10세적환자중 7례출현전비선전공능장애,34례>10세적환자중유 6례출현공능장애；미출현골근막간실종합정등병발증。절개복위내고정조중,38례>10세적환자중1례술후24h 내출현골근막간실종합정,1례출현골절연지유합,11례≤10세적환자중1례출현재골절；미출현내고정술후감염등병발증。량조병발증비교차이유통계학의의(P <0．05)。결론대우소인전비폐합골절,인≤10세적환자골막교후,유교강적소형능력,건의이수법복위석고외고정치료위주；이대우>10세혹경수법복위석고외고정불능유지골절단단은정적환자,가행수술내고정치료。
Objective To compare the manual reduction external fixation and open reduction internal fixation of the clinical outcome of pediatric forearm closed fracture. Methods 216 cases of patients with fracture of pediatric fore-arm closed information were retrospective analyzed, including 167 cases through reduction and external fixation, 49 cases were undergone open reduction and internal fixation. The outcomes were evaluated by comparing the effect and complication of the two methods. Results All patients were followed up for 3 ~ 24 months. Fracture healing time:manual reduction external fixation group was 4 ~ 11(6. 4 ± 1. 2) weeks , and open reduction internal fixation group was 6 ~ 15(8. 5 ± 1. 9) weeks. There was significant difference between both groups (P < 0. 05). According to the pain and the rotation angle of loss evaluation, the excellent-good rate of manual reduction external fixation group was 94. 0% , open reduction internal fixation group was 93. 9% . There was no significant difference for the excellent-good rate between both groups (P > 0. 05). In manual reduction external fixation group, 7 cases of 133 cases ( ≤10 years) got forearm rotation disfunctions, 6 cases of 34 cases ( > 10 years) got forearm rotation disfunctions. There were no other complications such as osteofacial compartment syndrome. In open reduction internal fixation group, 1 case of 38 cases ( > 10 years) developed osteofacial compartment syndrome during 24 hours postoperation, and 1 case got delayed union of fractures. 1 case of 11 cases (≤10 years) got re-fractures. There were no other complica-tions such as postoperative infection in posterior internal fixation. There was significant difference for the complica-tions between both groups (P < 0. 05). Conclusions Because of the thicker eardrum, for these patients older than 10 years, with good remodeling capability, manual reduction external fixation are suggested. For these patients less than 10 years, or the fragment ends fail to maintain stability by manual reduction external fixation, open reduction in-ternal fixation are suggested.