超声引导闭合复位外固定治疗儿童桡骨远端骨折

Ultrasound-guided closed reduction and external fixation for distal radius fractures in children

摘要:

［目的］ 比较髓内钉 （intramedullary nailing, IMN） 与微创经皮钢板 （minimally invasive percutaneous plate osteosynthe- sis, MIPPO）固定成人肱骨干骨折的疗效。［方法］回顾性分析 2016 年 1 月 1 日—2021 年 1 月 1 日收治的成人肱骨干骨折 59 例患者的临床资料。依据术前医患沟通结果，26 例采用 IMN 固定，33 例采用 MIPPO 固定。比较两组围手术期、随访和影像资料。［结果］两组均顺利完成手术，术后均未出现桡神经及肌皮神经麻痹。两组手术时间、术中失血量、切口愈合等级和住院时间的差异均无统计学意义 （P>0.05）。但是，MIPPO 组切口显著长于 IMN 组 （P<0.05），IMN 组术中透视次数及术后引流量显著多于 MIPPO 组（P<0.05）。两组患者均获随访 12 个月以上，随访过程中，骨不连并行翻修手术 IMN 组 4 例，而 MIPPO 组 0 例，差异有统计学意义（P<0.05）。肩部撞击痛并翻修 IMN 组 5 例，MIPPO 组 0 例，差异有统计学意义（P<0.05）。随术后时间推移，两组肩上举 ROM 和 UCLA 肩评分均显著改善（P<0.05）。术后各时间点，MIPPO 组的肩上举 ROM 和 UCLA 肩评分均显著优于 IMN 组（P<0.05）；但两组间肘伸屈 ROM 和 MEPS 评分的差异无统计学意义（P>0.05）。影像方面，两组骨折复位质量的差异无统计学意义（P>0.05），但是，MIPPO 组骨折影像骨折愈合时间显著早于 IMN 组（P<0.05）。［结论］本研究中 MIP- PO 治疗成人肱骨干骨折的临床效果显著优于 IMN。

Abstract:

[Objective] To investigate the clinical effect of ultrasound-guided closed reduction and fixation with modified mini-exter- nal fixator for unstable distal radius fractures in children. [Methods] From March 2017 to December 2020, 55 children with unstable frac- tures of the distal radius were enrolled in this study. According to doctor-patient communication results, 29 patients were treated with ultra- sound-guided closed reduction and fixation with modified mini-external fixator (the ultrasound group) , while the remaining 26 children were treated with traditional external fixator under fluoroscopy (the fluoroscopy group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation performed smoothly. The ultrasound group proved significantly superior to the fluoroscopy group in terms of operation time, imaging exposure times, intraoperative blood loss and hospital stay (P<0.05) . In addition, the WB-faces pain scores in the ultrasound group were significantly lower than those in the fluoroscopy group at 1day and 3 days postoperatively (P<0.05) . All patients in both groups were followed up for (18.53±4.24) months on average, with no signifi- cant differences in the time to remove external fixator and the time to resume full weight-bearing activity between the two groups (P>0.05) . Compared with those 3 months after surgery, the extension-flexion range of motion (ROM) and ulnar -radial deviation ROM significantly in- creased in both groups (P<0.05) , the Gartland-Werlay scores also improved in both groups at the last follow-up whereas without statistical- ly significant differences (P>0.05) . However, there were no significant differences in the abovesaid indexes between the two groups at any corresponding time points (P>0.05) . Radiographically, there was no significant difference in fracture reduction quality between the two groups (P>0.05) . The PT, RI and RL in both groups were significantly improved after operation (P<0.05) , whereas no significant differenc- es in the above imaging parameters were noticed between the two groups at corresponding time points (P>0.05) . [Conclusion] The ultra- sound-guided closed reduction and fixation with modified mini-external fixator does achieve considerably better clinical outcomes over the fluoroscopic closed reduction and conventional external fixator for distal radial unstable fractures in children.