Percutaneous Kirschner wire leverage plus plaster fixation versus elastic intramedullary nailing for radial neck fractures in children
张福勇 1刘文栋 1王晓东 1甄允方 1赵谈谈 2刘亚 1杨瑜豪 1邹岷成 1毛云鹏 1张以芳
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作者信息
1. 苏州大学附属儿童医院小儿骨科，苏州 215000
2. 苏州市吴江区儿童医院骨科，苏州 215200
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摘要
目的 比较经皮克氏针撬拨复位石膏固定与弹性髓内钉内固定治疗儿童桡骨颈骨折的疗效。 方法 回顾性分析2016年1月至2023年7月苏州大学附属儿童医院小儿骨科经皮克氏针撬拨复位石膏固定治疗的60例儿童桡骨颈骨折患者资料，设为无内固定组。男30例，女30例；左侧34例，右侧26例；年龄（7.7±3.0）岁。同时筛选同期60例与无内固定组患者年龄和性别相匹配的经皮克氏针撬拨复位弹性髓内钉内固定治疗的患者作对照，设为髓内钉组。比较两组患儿术前骨折成角角度、手术时间、住院时间、术后1 d骨折成角角度、术后1个月骨折成角角度、骨折复位后角度丢失率、末次随访时Mayo肘关节功能评分（MEPS）和并发症发生情况。 结果 两组患者术前一般资料比较差异均无统计学意义（P>0.05），具有可比性。120例患儿术后获（7.5±3.2）个月随访。无内固定组患儿的手术时间[（27.4±15.0）min]和住院时间[（3.4±1.9）d]均短于髓内钉组[（45.4±13.5）min、（4.4±1.3）d]，差异均有统计学意义（P<0.05）。无内固定组患儿的术前骨折成角角度（50.8°±1.9°）、术后1 d骨折成角角度（11.3°±1.2°）、术后1个月骨折成角角度（12.1°±1.3°）、角度丢失率（2.9%±0.5%）、末次随访时MEPS评分[（90.4±2.0）分]与髓内钉组[49.5°±1.7°、11.1°±1.2°、13.3°±1.5°、3.9%±1.4%、（90.2±2.3）分]比较差异均无统计学意义（P>0.05）。无内固定组术后无一例患者发生针尾刺激征和骨骺早闭，而髓内钉组术后有3例发生针尾刺激征和2例骨骺早闭，两组并发症发生率[0（0/60）vs. 8.3%（5/60）]比较差异有统计学意义（P<0.05）。 结论 经皮克氏针撬拨复位石膏固定与弹性髓内钉内固定治疗儿童桡骨颈骨折均可取得满意疗效，经皮克氏针撬拨复位石膏固定的手术时间和住院时间均更短，并发症更少，且无需二次手术去除内固定物。 Objective To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children. Methods A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups. Results There was no significant difference between the 2 groups in their preoperative general data, showing comparability (P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] (P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] (P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] (P<0.05). Conclusions Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.
Abstract
Objective To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children. Methods A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups. Results There was no significant difference between the 2 groups in their preoperative general data, showing comparability (P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] (P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] (P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] (P<0.05). Conclusions Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.
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