弹性髓内钉内固定治疗儿童尺桡骨骨折的临床疗效及美学效果探讨

董玉银，王 建，张文龙　杨西洲

[摘要]目的：探討弹性髓内钉内固定治疗儿童尺桡骨骨折的临床疗效及美学效果。方法：连续纳入2019年1月-2020年5月笔者医院收治的106例尺桡骨骨折患儿，按照随机数字法分为对照组与观察组，每组53例。对照组实施切开复位后钢板内固定术，观察组实施闭合复位后弹性髓内钉内固定术，术后随访6个月。记录两组手术时间、住院时间、骨折愈合时间、骨性愈合时间、腕关节功能、X-线评分、美学评分及术后并发症情况。结果：106例患儿均得到完整随访。观察组手术时间、住院时间、骨折愈合时间及骨性愈合时间均明显短于对照组，差异有统计学意义（P<0.05）。观察组与对照组的腕关节功能优良率分别为96.23%（51/53）、81.13%（43/53），差异有统计学意义（P<0.05）。术后1、3、6个月，观察组的X-线评分均明显优于对照组，差异有统计学意义（P<0.05）。观察组美学评分明显高于对照组，差异有统计学意义（P<0.05）。观察组术后并发症发生率明显低于对照组，差异有统计学意义（P<0.05）。结论：弹性髓内钉内固定术治疗儿童尺桡骨骨折的临床疗效及美学效果均显著优于钢板内固定。

[关键词]尺桡骨骨折;儿童;弹性髓内钉内固定;钢板内固定;美学效果

[中图分类号]R683.41    [文献标志码]A    [文章编号]1008-6455（2021）09-0045-03

Clinical Efficacy and Aesthetic Effect of Elastic Intramedullary Nail Internal Fixation in the Treatment of Ulnar and Radial Fractures in Children

DONG Yu-yin，WANG Jian，ZHANG Wen-long，YANG Xi-zhou

[Department of Orthopedics，Wanbei Coal-electricity Group General Hospital（the Third Affiliated Hospital of Bengbu Medical College），Suzhou 234000，Anhui，China]

Abstract： Objective  To discuss the clinical efficacy and aesthetic effect of elastic intramedullary nail internal fixation in the treatment of children with ulnar and radial fractures. Methods  A total of 106 children with ulnar and radial fractures who was successively included in our hospital from January 2019 to May 2020. According to the random number method， the 106 children were divided into the control group and the observation group， 53 children in each group. The children were treated with plate internal fixation after open reduction in the control group， while the children were treated with elastic intramedullary nail internal fixation after closed reduction in the observation group. All the children were followed up for 6 months after operation. The time of operation， hospital stays， fracture healing time， bone healing time， wrist function， X-ray scores， aesthetic ascores and postoperative complications were observed. Results  All the 106 cases were followed up completely. The time of operation， hospital stays， fracture healing time， bone healing time in the observation group was significantly shorter than those in the control group， the differences were statistically significant （P<0.05）. The excellent and good rate of wrist function in the observation group and the control group was 96.23%（51/53） and 81.13%（43/53） respectively， and the observation group was significantly higher than that in the control group（P<0.05）. At 1， 3 and 6 months after operation， the X-ray scores in the observation group was significantly better than those in the control group（P<0.05）. The aesthetic ascores of appearance in the observation group was significantly higher than that in the control group（P<0.05）. The incidence of postoperative complications in the observation group was significantly lower than that in the control group（P<0.05）. Conclusion  The elastic intramedullary nail internal fixation had significantly clinical efficacy and aesthetic effect in the treatment of children with ulnar and radial fractures， and it was superior to plate internal fixation.

Key words： ulnar and radial fractures; children; elastic intramedullary nail internal fixation; plate internal fixation; aesthetic effect

尺桡骨骨折是由于直接或间接暴力所导致的尺骨干与桡骨干同时发生的骨折，骨折后容易出现骨折错位，且维持固定较为困难，在儿童中较为常见，占儿童骨折类型的3%～6%[1]。若得不到积极有效的治疗，则会产生腕关节功能障碍、肢体畸形等不良预后[2]。对于儿童尺桡骨骨折，保守治疗是主要手段，具有操作简便、痛苦小、愈合快等优点，但是家属护理难度大、关节功能恢复较差，也可能发生骨折再次移位等[3]。虽然钢板内固定具有较强的抗扭曲能力，并且能够用于粉碎性骨折，但对骨膜破坏性大，不利于骨折愈合[4]。弹性髓内钉内固定术能够对骨折内环境起到稳定作用，具有很好的复位固定效果[5]，在临床骨外科领域得到越来越广泛的应用。……