关节造影辅助下经皮弹性髓内钉治疗儿童桡骨颈骨折的疗效观察
Clinical effects of percutaneous elastic intramedullary nail assisted by arthrography for the treatment of radial neck fractures in children
周慧敏 1许益文 1陶春杰 1范江荣 1游景扬 1阮家诚 1沈思齐 1王震 1郑勇1
作者信息
- 1. 咸宁市中心医院骨科,湖北 咸宁 437000
- 折叠
摘要
目的:探讨在关节造影辅助下闭合复位经皮弹性髓内钉治疗儿童桡骨颈骨折的临床疗效.方法:回顾性分析2019年1月至2022年12月关节造影辅助下闭合复位经皮弹性髓内钉内固定术治疗的23例桡骨颈骨折患儿(关节造影结合弹性钉组)的临床资料,男12例,女11例;年龄2～12(7.36±1.89)岁;根据Judet骨折分型,Ⅲ型14例,Ⅳ型9例.另选取2015年1月至2018年12月采用闭合复位经皮弹性髓内钉内固定术治疗的23例儿童桡骨颈骨折患儿(弹性钉组)的临床资料,其中男11例,女12例;年龄2～14(7.50±1.91)岁;Judet分型,Ⅲ型15例,Ⅳ型8例.比较两组手术时间、术中透视次数,采用Metaizeau评价标准评估骨折复位情况,Tibone-Stoltz标准评价两组肘关节功能恢复情况.结果:两组患儿获得随访,时间12～24(16.56±6.34)个月.弹性钉组手术时间、术中透视次数分别为(56.64±19.27)min、(21.13±7.87)次,关节造影结合弹性钉组手术时间、术中透视次数为(40.33±11.50)min、(12.10±3.52)次,两组比较差异有统计学意义(P＜0.05).根据Metaizeau评价标准,关节造影结合弹性钉组优11例,良9例,可3例,差0例;弹性钉组优5例,良13例,可4例,差1例;两组比较,差异有统计学意义(P＜0.05).肘关节功能按照Tibone-Stoltz 标准评价,关节造影结合弹性钉组优14例,良8例,可1例,差0例;弹性钉组优12例,良9例,可1例,差1例;两组比较,差异无统计学意义(P＞0.05).结论:关节造影辅助下闭合复位经皮弹性髓内钉内固定术较经皮弹性髓内钉内固定术具有手术时间短、术中透视次数少,骨折复位良好的优势,关节造影可将儿童桡骨头颈骨软骨等解剖结构显影,充分显示骨折复位及肱桡关节对位情况,更精准地指引弹性髓内钉植入桡骨颈的深度,提高手术效率和成功率.
Abstract
Objective To explore clinical effect of closed reduction percutaneous elastic intramedullary nail assisted by arthrography in the treatment of radial neck fracture in children.Methods A retrospective analysis was performed on 23 chil-dren with radial neck fracture treated with arthrography assisted closed reduction and percutaneous elastic intramedullary nail internal fixation(arthrography with elastic nail group)from January 2019 to December 2022,including 12 males and 11 fe-males,aged from 2 to 12 years old with an average of(7.36±1.89)years old;According to Judet fracture types,14 children were type Ⅲ and 9 children were type Ⅳ.In addition,23 children with radial neck fracture were selected from January 2015 to December 2018 who were treated with closed reduction and percutaneous elastic intramedullary nail fixation(elastic nail group),including 11 males and 12 females,aged from 2 to 14 years old with an average of(7.50±1.91)years old;Judet classi-fication included 15 children were type Ⅲ and 8 children were type Ⅳ.Operative time and intraoperative fluoroscopy times were compared between two groups.Metaizeau evaluation criteria was used to evaluate fracture reduction,and Tibone-Stoltz evaluation criteria was used to evaluate functional recovery of elbow between two groups.Results Both groups were followed up for 12 to 24 months with an average of(16.56±6.34)months.Operative time and intraoperative fluoroscopy times of elastic nail group were(56.64±19.27)min and(21.13±7.87)times,while those of joint angiography with elastic nail group were(40.33±1 1.50)min and(12.10±3.52)times;there were difference between two groups(P＜0.05).According to Metaizeau evaluation,11 patients got excellent result,9 good and 3 fair in joint angiography with elastic nail group,while in elastic nail group,5 ex-cellent,13 good,4 acceptable,and 1 poor;the difference between two groups was statistically significant(P＜0.05).According to Tibone-Stoltz criteria,14 patients got excellent result,8 good,and 1 fair in joint arthrography with elastic nail group;while in elastic nail group,12 patients got excellent result,9 good,1 fair and 1 poor;there was no significant difference between two groups(P＞0.05).Conclusion Compared to percutaneous elastic intramedullary nail fixation,closed reduction assisted by arthrography has advantages of reduced operation time,decreased intraoperative fluoroscopy frequency,and improved fracture reduction.Arthrography enables clear visualization of the anatomical structures of radius,head,neck,bone,and cartilage in children,facilitating comprehensive display of fracture reduction and brachioradial joint alignment.This technique more pre-cisely guides the depth of elastic intramedullary nail implantation in radius neck,thereby enhancing surgical efficiency and success rate.
关键词
关节造影/弹性髓内钉/儿童/桡骨颈骨折Key words
Arthrography/Elastic intramedullary nail/Children/Radial neck fractures引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据