摘要
目的 探讨钛制弹性髓内钉（ESIN）固定技术治疗儿童孟氏骨折的适应证和疗效， 方法 回顾性分析2005年1月至2012年12月治疗并完成随访的27例儿童孟氏骨折患者资料,男15例,女12例;受伤时年龄为4.0～13.3岁（平均7.3岁），左侧12例,右侧15例，骨折按Bado分型：Ⅰ型19例,Ⅲ型5例,Ⅳ型3例，1例Ⅳ型尺骨骨折行切开复位钢板固定,桡骨骨折行ESIN固定;其他患者尺骨骨折均采用闭合复位ESIN固定，2例患者肱桡关节行切开复位,其余均为闭合复位，术后根据X线片评估骨折复位效果,末次随访时按Bruce-Harvey-Wilson评分系统评定疗效，结果 所有患者术后随访时间为10 ～31个月（平均18个月），骨折完全愈合（骨痂成熟、髓腔再通）时间为12 ～ 33周,平均20周，完成固定后的X线片示骨折复位情况：22例为优,5例为良，末次随访时按Bruce-Harvey-Wilson评分系统评定疗效：优26例,良1例,优良率为100％.术后未发生骨化性肌炎、volkmann缺血挛缩和皮肤激惹或针尾外露等并发症， 结论 ESIN固定技术简单实用、创伤小、并发症少,对于保守治疗失败或伴有Gustilo Ⅰ型开放性伤口的儿童孟氏骨折,不失为一种有效的治疗方式。
Objective To discuss the indications,surgical techniques and prognosis of pediatric Monteggia fractures treated with elastic stable intramedullary nail （ESIN）.Methods In the period between January 2005 to December 2012,27 children with Monteggia fractures were treated with ESIN and completely followed up by authors.They were 15 boys and 12 girls,aged from 4.0 to 13.3 years （average,7.3 years）.The injury affected 12 left sides and 15 right sides.According to the Bado classification system,19 cases were of type Ⅰ,5 of type Ⅲ and 3 of type ⅣV.In Bado types Ⅰ and Ⅲ,the ulnar fractures were treated with closed reduction and internal fixation using ESIN.In 2 cases of Bado type Ⅳ,fractures of the ulna and radius were fixated with ESIN.In another case of Bado type Ⅳ,the ulnar facture was fixated with plate and the radial fracture with ESIN.The radiohumeral joints were treated with open reduction in only 2 cases,and with closed reduction in the rest.The reduction was evaluated by the postoperative X-ray films and the therapeutic outcomes were assessed by the Bruce-Harvey-Wilson evaluation system.Results The follow-up period ranged from 10 months to 31 months （average,18 months）.All fractures united without infection,myositis ossificans,Volkmann ischemic contracture or skin irritation.Complete healing （mature callus and medullary cavity recanalization） was achieved after 12 to 33 weeks （average,20 weeks）.According to the postoperative radiographs,22 cases were considered excellent and 5 cases good.According to the Bruce-Harvey-Wilson scoring system,26 cases were considered excellent and one good.Conclusion Since the technique of ESIN is simple,practical and minimally invasive,and leads to fewer complications,it is an effective treatment for pediatric Monteggia fractures,especially after failed conservative management and for those associated with Gustilo type Ⅰ open wound.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2014年第10期848-852,共5页
Chinese Journal of Orthopaedic Trauma
关键词
尺骨骨折
骨折固定术
髓内
儿童
Ulna fractures
Fracture fixation, intramedullary
Child
