预成型弹性髓内钉固定儿童桡骨远端干骺端骨折

Preformed elastic intramedullary nail fixation for distal radius diaphyseal metaphyseal junction fractures in children

摘要:

[目的] 探讨预成型弹性髓内钉（elastic stable intramedullary nail, ESIN） 固定治疗儿童桡骨远端干骺端骨折（distalradius diaphyseal metaphyseal junction fracture, DRDMJ） 的效果。[方法] 回顾性分析2020 年1 月—2022 年9 月于本院就诊的80例DRDMJ 患儿的临床资料。根据医患沟通结果，40 例采用透视下改良三维重建指导预成型逆行ESIN 固定术（预成型组），40例采用透视下逆行ESIN 固定术（未成型组）。比较两组患者围术期、随访及影像资料。[结果] 两组手术时间、切口长度、术中透视次数、术中出血量、切口愈合等级、主动活动时间以及住院时间的差异均无统计学意义（P＞0.05）。随访时间平均（15.0±3.5） 个月，两组完全负重活动时间的差异无统计学意义（P＞0.05）。随时间推移，两组MEPS 评分、Cooney 腕评分均显著增加（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）。预成型组随访期间发生术后骨折二次移位发生率显著低于未成型组[例(%), 4/40 (10.0) vs 11/40 (27.5), P=0.045]。影像方面，与术前相比，术后4 周、末次随访时两组掌倾角（palmar tilt, PT）、尺偏角（radial inclination, RI）、桡骨茎突长度（radial length, RL） 均显著增加（P＜0.05）。术后4 周、末次随访时预成型组PT [(8.9±2.4)° vs (7.6±2.1)°, P=0.012; (11.3±2.0)° vs (10.4±1.8)°, P=0.038]、RL [(7.6±2.1) mm vs (6.5±2.0) mm, P=0.019; (9.6±1.7) mm vs (8.8±1.8) mm, P=0.044] 显著优于未成型组。[结论] 预成型逆行ESIN 固定术应用于儿童DRDMJ 中，可改善术后骨折复位情况，对降低术后骨折二次移位发生率具有重要意义。

Abstract:

[Objective] To explore the clinical outcomes of preformed elastic intramedullary nail (ESIN) fixation for distal radius diaph-yseal metaphyseal junction fracture (DRDMJ) in children. [Methods] A retrospective analysis was conducted on 80 children who receivedsurgical treatment for DRDMJ in our hospital from January 2020 to September 2022. According to doctor-patient communication, 40 casesunderwent retrograde ESIN preformed accoding to 3D CT reconstruction (the preformed group), while other 40 cases underwent convention-al retrograde ESIN fixation (the non-preformed group). The documents regarding perioperative period, follow-up, and images were com-pared between two groups. [Results] There was no statistically significant difference in surgical time, incision length, intraoperative fluoros-copy frequency, intraoperative bleeding, incision healing grade, active activity time, and hospitalization time between the two groups (P＞0.05). All children in both groups were followed up for (15.0 ± 3.5) months in a mean, and there was no statistically significant difference intime to resume full weight-bearing activity between the two groups (P＞0.05). The MEPS score and Cooney wrist score significantly in-creased in both groups (P＜0.05) over time, which proved not statistically significant between the two groups at any time points accordingly(P＞0.05). The preformed group had significantly lower incidence of postoperative fracture displacement during follow-up than the non-pre-formed group [4/40 (10.0%) vs 11/40 (27.5%), P=0.045]. As for imaging, compared with those before surgery, the palmar tilt (PT), radial in-clination (RI), and radial length (RL) in both groups significantly increased 4 weeks postoperatively and at the last follow-up (P＜0.05). At 4weeks after surgery and the last follow-up, the preformed group proved significantly superior to the non-preformed group in terms of PT[(8.9±2.4)° vs (7.6±2.1)°, P=0.012; (11.3±2.0)° vs (10.4±1.8)°, P=0.038] and RL [(7.6±2.1) mm vs (6.5±2.0) mm, P=0.019; (9.6±1.7) mm vs(8.8±1.8) mm, P=0.044]. [Conclusion] The preformed retrograde ESIN fixation for pediatric DRDMJ does improve postoperative fracture re-duction, and is of great significance in reducing the incidence of secondary fracture displacement.