超声引导下儿童前臂骨折复位弹性髓内针内固定△

Ultrasound-guided closed reduction and internal fixation with elastic intramedullary nail for forearm fracture in children

摘要:

[目的] 探讨超声引导下儿童尺桡骨骨折手法复位弹性髓内针固定的临床疗效。[方法] 回顾性分析 2019 年 9 月— 2021 年 7 月本科采用闭合复位弹性髓内针固定治疗前臂骨折 60 例患儿的临床资料。根据医患沟通结果，30 例采用超声引导复位固定，另外 30 例采用透视引导复位固定。比较两组围手术期、随访及影像资料。[结果]两组患儿均顺利完成手术，术中无神经、血管损伤等严重并发症。超声组在手术时间 [(23.4±3.6) min vs (31.9±3.5) min, P＜0.05]、术中失血量 [(4.5±2.7) ml vs (6.7± 4.5) ml, P＜0.05]、术中透视次数 [(3.2±1.5) 次 vs (10.4±2.1) 次, P＜0.05]、住院时间 [(3.2±1.5) d vs (4.2±1.0) d, P＜0.05]、去除外固定时间 [(28.0±5.3) d vs (32.3±3.2) d, P＜0.05] 均显著优于透视组；但是两组间切口长度、切口愈合等级的差异均无统计学意义 （P＞ 0.05）。超声组初次闭合复位成功率显著高于透视组 （96.7% vs 70.0%, P＜0.05）。与术前相比，两组术后 VAS 评分均显著减少 （P＜0.05），相应时间点，两组间 VAS 评分的差异均无统计学意义（P＞0.05）。两组患儿完全负重活动时间的差异无统计学意义 （P＞0.05），与术后 3 个月相比，两组术后 12 个月 DASH 评分、前臂旋转 ROM、肘伸屈 ROM、腕伸屈 ROM 均显著改善 （P＜ 0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，两组骨折复位质量 、骨折愈合时间的差异均无统计学意义（P＞0.05）。[结论]儿童前臂骨折闭合手法复位弹性髓内针固定中应用超声引导，可减少患儿放射损伤，提高初次闭合复位成功率，缩短手术时间。

Abstract:

[Objective] To evaluate the clinical efficacy of ultrasound guided closed reduction and internal fixation with elastic intra- medullary nail for forearm fractures in children. [Methods] A retrospective study was performed on 60 children who received closed reduc- tion and percutaneous elastic intramedullary nail fixation for forearm fractures from September 2019 to July 2021. According to the preoper- ative doctor-patient communication, 30 children had operation performed under ultrasound guidance, while other 30 children were under fluoroscopy guidance. The perioperative, follow- up and imaging data of the two groups were compared. [Results] All children in both groups were operated on smoothly, with no neurovascular injury and other serious complications during the operation. The ultrasound group proved significantly superior to the fluoroscopy group in terms of operation time [(23.4±3.6) min vs (31.9±3.5) min, P＜0.05], intraoperative blood loss [(4.5±2.7) ml vs (6.7±4.5) ml, P＜0.05], intraoperative fluoroscopy times [(3.2±1.5) times vs (10.4±2.1) times, P＜0.05], the hospi- tal stay [(3.2±1.5) days vs (4.2±1.0) days, P＜0.05], external fixation removal time [(28.0±5.3) days vs (32.3±3.2) days, P＜0.05], despite insig- nificant differences in incision length and incision healing grade between two groups (P＞0.05). In addition, the ultrasound group got signifi- cantly higher success rate of initial closed reduction than the fluoroscopy group (96.7% vs 70.0%, P＜0.05). Postoperative pain VAS scores significantly declined in both groups over time (P＜0.05), which was not significant between the two groups at any corresponding time points (P＞0.05). Regarding the data of follow-up, there was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05). The DASH score, forearm rotation ROM, elbow extension ROM and wrist extension ROM significantly improved in both groups at 12 months after surgery compared with those 3 months postoperatively (P＜0.05), whereas which were not statistically signifi-cant between the two groups at any time points accordingly (P＞0.05). In terms of imaging, there were no significant differences in the quali- ty of fracture reduction and healing time between the two groups (P＞0.05). [Conclusion] The ultrasonic guided closed reduction and percu- taneous elastic intramedullary pin fixation for forearm fracture in children does reduce radiation injury, improve the success rate of initial closed reduction and shorten the operation time.