CAJ | 학술논문

目的探讨经皮撬拨复位克氏针固定治疗儿童桡骨颈O'BrienⅡ、Ⅲ型骨折的临床效果.方法回顾性分析2010年3月至2013年2月治疗的16例桡骨颈O'BrienⅡ、Ⅲ型骨折患儿资料,男10例,女6例;年龄6～ 14岁;左侧12例,右侧4例;均为跌倒致伤.桡骨颈骨折按O'Brien分型:Ⅱ型9例、Ⅲ型7例;2例合并尺骨近端骨折,1例合并肱骨内上髁骨折.患儿临床表现为肘关节外侧肿胀;压痛明显,疼痛视觉模拟评分6.5～ 9.2分,平均7.9分;肘关节活动受限,受伤时肘关节屈曲、伸直、旋前及旋后平均度数为78°±3°、-54°±4°、9°±3°及5°±3°;受伤至手术时间2～4d,平均2.8d.“C”型臂X线机辅助下采用直径2 mm克氏针插入骨折断端撬拨复位,骨折复位后打入撬拨的克氏针.术后长臂石膏托固定肘关节于功能位4周,去石膏托后拔除克氏针行康复训练.结果 16例患儿均获得随访,随访时间6～ 24个月,平均11.8个月;其中14例骨折解剖复位,无一例出现术后复位丢失、骨间背侧神经损伤及针道感染等;手术时间20～ 35 min,平均30 min;骨折均愈合,愈合时间4～6周,平均4.1周.末次随访终时肘关节屈曲、伸直、旋前及旋后平均度数为136°±4°、-2°±2°、81°±4°及75°±4°;无一例合并桡骨头缺血性坏死,1例患儿术后15个月出现桡骨近端骺板早闭,为O'BrienⅢ型桡骨颈骨折,未进一步治疗;根据Metaizeau评估标准,优8例、良7例、可1例;优良率为93.8％(15/16).结论对于儿童桡骨颈O'BrienⅡ、Ⅲ型骨折,经皮撬拨复位克氏针固定是一种有效的治疗方法,操作简单,疗效肯定.
목적 탐토경피효발복위극씨침고정치료인동뇨골경O'BrienⅡ、Ⅲ형골절적림상효과.방법 회고성분석2010년3월지2013년2월치료적16례뇨골경O'BrienⅡ、Ⅲ형골절환인자료,남10례,녀6례;년령6～ 14세;좌측12례,우측4례;균위질도치상.뇨골경골절안O'Brien분형:Ⅱ형9례、Ⅲ형7례;2례합병척골근단골절,1례합병굉골내상과골절.환인림상표현위주관절외측종창;압통명현,동통시각모의평분6.5～ 9.2분,평균7.9분;주관절활동수한,수상시주관절굴곡、신직、선전급선후평균도수위78°±3°、-54°±4°、9°±3°급5°±3°;수상지수술시간2～4d,평균2.8d.“C”형비X선궤보조하채용직경2 mm극씨침삽입골절단단효발복위,골절복위후타입효발적극씨침.술후장비석고탁고정주관절우공능위4주,거석고탁후발제극씨침행강복훈련.결과 16례환인균획득수방,수방시간6～ 24개월,평균11.8개월;기중14례골절해부복위,무일례출현술후복위주실、골간배측신경손상급침도감염등;수술시간20～ 35 min,평균30 min;골절균유합,유합시간4～6주,평균4.1주.말차수방종시주관절굴곡、신직、선전급선후평균도수위136°±4°、-2°±2°、81°±4°급75°±4°;무일례합병뇨골두결혈성배사,1례환인술후15개월출현뇨골근단후판조폐,위O'BrienⅢ형뇨골경골절,미진일보치료;근거Metaizeau평고표준,우8례、량7례、가1례;우량솔위93.8％(15/16).결론 대우인동뇨골경O'BrienⅡ、Ⅲ형골절,경피효발복위극씨침고정시일충유효적치료방법,조작간단,료효긍정.
Objective To evaluate the outcome of percutaneous K-wire leverage reduction and fixation for O'Brien Ⅱ,Ⅲ pediatric radial neck fracture.Methods From March 2010 to February 2013,16 children with O'Brien Ⅱ,Ⅲ pediatric radial neck fracture were operated in our hospital.There were 6 females and 10 males aged from 6 to 14 years old.There were 12 left arms and 4 right arms.Concomitant injuries included proximal ulna fractures in 2 cases and medial epicondyle fracture of humerus in 1 case.All children present a swollen and painful elbow with loss of rotation and pain on pronation and supination.The mean visual analogue score (VAS) was 7.9 (range,6.5-9.2).The flextion,extention,pronation and supination of elbow were 78°±3°,-54°±4°,9°±3° and 5°±3° in average.All cases were classified by the O'Brien system,including 9 cases of Ⅱ type and 7 cases of Ⅲ type.Mechanism of injury was fall from a height.The interval between injury and surgery averaged 2.8 days.Percutaneous leverage reduction and fixation were performed for 16 patients.After confirming successful reduction,the wire was advanced to the far cortex of the radius and penetrated into the far cortex to maintain the reduction status.4 weeks of long-arm cast followed by functional exercises were carried out for all patients.We analyzed radiographs and clinical results according to the criteria suggested by Metaizeau.Results 16 patients were followed up for 11.8 month in average after operation.14 patients were gained anatomical reduction.No patient had posterior interosseous nerve injury,fracture redisplacement and pin site infection.All fractures healed in a mean of 4.1 weeks.The follow-up flextion,extention,pronation and supination of elbow were 136°±4°,-2°±2°,81 °±4° and 75°±4° in average.Follow-up radiographs showed no patient had avascular necrosis of radial head.One patient had physeal arrest after 15 months of operation and outpatient follow-up observation were conducted.According to Metaizeau function scale,8 were excellent,7 good and 1 fair.The healing rate was 93.8％ (15/16).Conclusion Percutaneous joystick reduction and fixation technique have good effect for O'Brien Ⅱ,Ⅲ pediatric radial neck fracture,which is simple and easy to master.