顺行与逆行弹性髓内钉固定儿童桡骨远端干骺区骨折比较

Anterograde elastic intramedullary nailing versus retrograde counterpart for distal radius metaphyseal fractures in children

摘要:

[目的]比较顺、逆行弹性髓内钉治疗儿童桡骨远端干骺区骨折的疗效。[方法]回顾性分析 2018 年 2 月—2023 年 2 月本科采用髓内钉固定桡骨远端干骺区骨折的 40 例患儿的临床资料。根据医患沟通结果，20 例采用顺行弹性髓内钉治疗， 20 例采用逆行弹性髓内钉治疗。比较两组围手术期、随访和影像资料。[结果] 两组患者均顺利完成手术。顺行组手术时间 [(41.6±2.3) min vs (50.8±3.8) min, P＜0.001]、术中透视次数 [(11.0±1.8) 次 vs (12.5±1.3) 次, P=0.011]、术中失血量 [(4.2±0.8) mL vs (5.1±0.7) mL, P=0.002] 显著优于逆行组。随访时间平均（14.5±1.1）个月，与术后 3 个月相比，末次随访时顺行组 Gartland-Wer- lay 评分无显著变化（P＜0.05），逆行组的 Gartland-Werlay 评分显著减少（P＜0.05），两组腕伸-屈 ROM、尺偏-桡偏 ROM、旋前旋后 ROM 均显著增加（P＜0.05）。顺行组术后 3 个月 Gartland-Werlay 评分 [(1.0±1.0) vs (1.7±1.1), P=0.038] 显著优于逆行组。影像方面，顺行组骨折复位质量 [例, 优/良/差, (16 /4 /0) vs (10/5 /5), P=0.039] 及骨折影像愈合时间 [例, ＜4 周/4~6 周/≥6 周, (5/12/3) vs (3/ 10 /7) , P=0.013] 均显著优于逆行组。[结论]顺、逆行弹性髓内钉治疗儿童桡骨远端干骺区骨折均可取得良好的疗效，顺行弹性髓内钉临床效果优于逆行弹性髓内钉。

Abstract:

[Objective] To compare the clinical efficacy of anterograde elastic intramedullary nailing versus and retrograde counterpart for distal radius metaphyseal fractures in children. [Methods] A retrospective analysis was performed on 40 children who had distal radius metaphyseal fractures fixed with elastic intramedullary nails from February 2018 to February 2023. According to doctor-patient communication, 20 patients were treated with anterograde elastic intramedullary nailing (AEIN), while other 20 patients were with retrograde elastic intramedullary nailing (REIN). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All children in both groups had operation performed successfully. The AEIN group proved significantly superior to the REIN group in terms of operation time [(41.6±2.3) min vs (50.8±3.8) min, P＜0.001], intraoperative fluoroscopy times [(11.0±1.8) times vs (12.5±1.3) times, P=0.011] and intraoperative blood loss [(4.2±0.8) mL vs (5.1±0.7) mL, P=0.002]. The mean follow-up time was of (14.5±1.1) months. Compared with that 3 months after surgery, the Gartland-Werlay score in the AEIN group had no significant change at the last follow-up (P＜0.05), while which in the REIN group was significantly decreased (P＜0.05). Wrist extension-flexion ROM, ulnar-radial ROM and pronation-supination ROM were significantly increased in both groups over time (P＜0.05). The AEIN group was significantly better than the REIN group in Gartland-Werlay score [(1.0±1.0) vs (1.7±1.1), P=0.038] 3 months after surgery. As for images, the AEIN group was also significantly better than the REIN group in terms of fracture reduction quality [excellent/good/bad, (16/4/0) vs / 5 (10/5), P=0.039] and fracture healing time on imaging [＜4 weeks /4~6 weeks / ≥6 weeks, (5/12/3) vs (7/3/10), P=0.013]. [Conclusion] Both anterograde and retrograde elastic intramedullary nails do achieve good clinical consequence for distal radius metaphyseal fractures in children. By comparison, the anterograde elastic intramedullary nailing is superior to the retrograde elastic intramedullary nailing.