闭合复位经皮克氏针与石膏固定治疗儿童桡骨远端Salter-HarrisⅠ型/Ⅱ型骨骺骨折的临床效果

刘琦 苏联彬 李楠竹

*基金项目：厦门市医疗卫生指导性项目（3502Z20209268）

【摘要】 目的：研究闭合复位经皮克氏针与石膏固定治疗儿童桡骨远端Salter-HarrisⅠ型/Ⅱ型骨骺骨折的临床效果。方法：选择厦门大学附属第一医院2017年9月—2023年6月收治的桡骨远端Salter-HarrisⅠ型/Ⅱ型骨骺骨折患儿86例为研究对象。按照随机数字表法将患儿分为两组。对照组43例，接受常规闭合复位联合石膏固定治疗；观察组43例，接受闭合复位经皮克氏针联合石膏固定治疗。对比两组的临床效果、疼痛程度、腕关节功能、并发症发生情况、骨折愈合时间及固定物拆除时间。结果：观察组临床总有效率为97.67%，高于对照组的81.40%（P<0.05）。治疗前两组患儿的骨折部位疼痛程度基本一致，差异无统计学意义（P>0.05）；但观察组治疗后48 h及出院后1周的疼痛评分均低于对照组（P<0.05）。治疗前两组的腕关节患者自行评估（PRWE）评分，差异无统计学意义（P>0.05）；治疗后，观察组的PRWE评分为（47.32±6.18）分，对照组为（48.62±6.34）分，差异无统计学意义（P>0.05）。观察组的并发症发生例数为1例，占比2.33%，而对照组的并发症发生例数为9例，占比20.94%，两组比较差异有统计学意义（P<0.05）。观察组骨折愈合时间短于对照组，固定物拆除时间早于对照组（P<0.05）。结论：闭合复位经皮克氏针与石膏固定在治疗儿童桡骨远端Salter-HarrisⅠ型/Ⅱ型骨骺骨折中的临床效果较好，有效缓解疼痛，降低并发症发生率，缩短骨折愈合时间及固定物拆除时间。

【关键词】 儿童桡骨远端骨骺骨折 闭合复位 经皮克氏针 石膏固定 并发症

Clinical Effect of Closed Reduction Percutaneous Kirschner Wire and Plaster Fixation in the Treatment of Salter-Harris Type Ⅰ/Ⅱ Epiphyseal Fractures of the Distal Radius in Children/LIU Qi， SU Lianbin， LI Nanzhu. //Medical Innovation of China， 2024， 21（14）： 00-005

[Abstract] Objective： To study the clinical effect of closed reduction percutaneous Kirschner wire and plaster fixation in the treatment of Salter-Harris type Ⅰ/Ⅱ epiphyseal fractures of the distal radius in children. Method： A total of 86 children with Salter-Harris type Ⅰ/Ⅱ epiphyseal fractures of the distal radius admitted to the First Affiliated Hospital of Xiamen University from September 2017 to June 2023 were selected as the study subjects， they were divided into two groups according to the random number table method. 43 cases in the control group received conventional closed reduction combined with plaster fixation treatment; 43 cases in the observation group received closed reduction and percutaneous Kirschner wire combined with plaster fixation treatment. The clinical outcomes， degree of pain， wrist joint function， incidence of complications， fracture healing time， and fixation removal time between the two groups were compared. Result： The total clinical effective rate of the observation group was 97.67%， which was higher than 81.40% in the control group （P<0.05）. Before treatment， the pain degree of the fracture site was basically the same between the two groups， there was no statistical significance （P>0.05）; however， the pain scores of the observation group 48 h after treatment and 1 week after discharge were lower than those of the control group （P<0.05）. There was no significant difference in the patient-rated wrist evaluation （PRWE） scores between the two groups before treatment （P>0.05）; after treatment， the PRWE score of the observation group was （47.32±6.18） points， and that of the control group was （48.62±6.34） points， with no statistical significance （P>0.05）. The number of complications in the observation group was 1 case， accounting for 2.33%， while the number of complications in the control group was 9 cases， accounting for 20.94%， the difference between the two groups was statistically significant （P<0.05）. The fracture healing time of observation group was shorter than that of control group， and the fixation removal time was earlier than that of control group （P<0.05）. Conclusion： The clinical effect of closed reduction percutaneous Kirschner wire and plaster fixation in the treatment of Salter-Harris type Ⅰ/Ⅱ epiphyseal fractures of the distal radius in children is good， effectively relieving pain， reducing the incidence of complications， shortening fracture healing time and fixation removal time.

[Key words] Pediatric distal radius epiphyseal fracture Closed reduction Percutaneous Kirschner wire Plaster fixation Complications

First-author's address： Department of Pediatric Orthopedics， the First Affiliated Hospital of Xiamen University， Xiamen 361003， China

doi：10.3969/j.issn.1674-4985.2024.14.001

儿童桡骨远端骨骺骨折是一种常见的骨折类型，主要分型为Salter-Harris Ⅰ型/Ⅱ型经骺板骨折，其患病率相对较高[1-2]。儿童骨骺骨折若没得到良好复位且维持复位，易引起骨骺早闭等问题，造成生长紊乱，桡骨远端生长障碍，甚至畸形。因人体的腕关节部位活动较为频繁，骨折后其对功能恢复方面的要求较高，若处理不当，极易引起关节疼痛或僵硬，给患者的生活造成不便[3]。临床治疗过程中，医生会根据损伤机制、骨折类型和患者的个体差异，采用不同的固定和复位方法，以有效恢复其关节活动度[4]。儿童……