中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (9): 1680-1685.doi: 10.3969/j.issn.1673-8225.2011.09.039

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

微创克氏针置入并外固定架修复桡骨远端不稳定骨骺骨折

任  一1，胡建山1，李  溥1，宋锡伦1，唐广应1，岑石强2，陈其宽1，曹杨彬1，冯  麟3，余学文1   

  1. 1贵州省黔南州中医院(贵阳中医学院第三附属医院)骨科，贵州省都匀市  558000
    2四川大学华西医院骨科，四川省成都市  610041
    3贵阳中医学院针灸系，贵州省贵阳市  550000
  • 收稿日期:2010-11-25 修回日期:2011-01-17 出版日期:2011-02-26 发布日期:2011-02-26
  • 作者简介:任一，男，1979年生，贵州省贵阳市人，汉族，2002年遵义医学院毕业，主治医师，主要从事手、显微外科、小儿创伤及矫形骨科研究。 renyi3939@yahoo.cn
  • 基金资助:

    国家中医药管理局“十一五”期间骨伤科重点专科能力建设项目(24JZX1L116K110)。

Minimally invasive Kirschner wire combined with external fixation for repair of unstable distal epiphyseal fracture of radius

Ren Yi1, Hu Jian-shan1, Li Pu1, Song Xi-lun1, Tang Guang-ying1, Cen Shi-qiang2, Chen Qi-kuan1, Cao Yang-bin1, Feng Lin3,Yu Xue-wen1   

  1. 1Department of Orthopaedics, Qiannan Traditional Chinese Medical Hospital (Third Affiliated Hospital of Guiyang College of Traditional Chinese Medicine), Duyun  558000, Guizhou Province, China
    2Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu  610041, Sichuan Province, China
    3Department of Acupuncture, Guiyang College of Traditional Chinese Medicine, Guiyang  550000, Guizhou Province, China
  • Received:2010-11-25 Revised:2011-01-17 Online:2011-02-26 Published:2011-02-26
  • About author:Ren Yi, Attending physician, Department of Orthopaedics, Qiannan Traditional Chinese Medical Hospital (Third Affiliated Hospital of Guiyang College of Traditional Chinese Medicine), Duyun 558000, Guizhou Province, China renyi3939@yahoo.cn
  • Supported by:

    the Key Item for Traumatology Construction of State Administration of Traditional Chinese Medicine of China during the “Eleventh-five-year Plan”, No. 24JZX1L116K110*

PDF

475

被引次数

24

摘要：

背景：单纯使用克氏针或外固定架治疗桡骨远端骨骺骨折的临床实践中，仍存在桡骨短缩、骨折移位等固定后并发症，尤其在不稳定骨骺骨折情况下。克氏针主要治疗桡骨远端骨折，对其骨骺骨折使用相对较少。
目的：观察外固定支架结合经皮克氏针复位固定微创治疗桡骨远端不稳定性骨骺骨折的临床效果。
方法：对90例桡骨远端骨骺骨折患儿行固定治疗，在不切开情况下微创闭合复位骨折骨骺，随机分成2组，对照组采用单纯跨腕关节外固定支架固定方案；观察组采用跨腕关节外固定支架结合经皮克氏针闭合帮助复位固定骨骺骨折方案。固定后行腕关节功能锻炼，分别于固定后9周及24个月随访观察。对比两组患者固定后中远期的临床疗效、腕关节功能恢复及X射线检查情况。
结果与结论：固定后24个月随访按Cooney标准评定腕关节功能，对照组优良率77%，X射线评定优良率63%；观察组腕关节功能优良率93%，X射线评定优良率为90%，两组差异具有显著性意义(P < 0.01)。两组骨骺骨折患者均获临床骨愈合，腕关节均功能恢复。提示外固定支架结合克氏针闭合复位微创治疗桡骨远端不稳定骨骺骨折，可应用克氏针辅助复位掌倾角及尺偏角，治疗简单，固定可靠，腕关节功能恢复良好，骨骺畸形愈合并发症少，固定后基本生活学习功能恢复正常，疗效稳定满意，其临床疗效明显优于单纯跨外固定支架固定。

关键词: 桡骨, 骨折, 外固定架, 微创, 闭合复位, 骨骺, 克氏针

Abstract:

BACKGROUND: Postoperative complications, such as radial shortening and displacement of fractures, still exist in the clinical practice of treatment of distal radius fracture with only Kirschner wire or external fixation, especially in the treatment of unstable epiphyseal fracture. Kirschner wire is mainly indicated in distal radius fracture and it is rarely applied on the treatment of epiphyseal fracture.
OBJECTIVE: To explore the clinical curative effects of the minimally invasive treatment of unstable distal epiphyseal fracture of radius with the combination of external fixation and reduction and percutaneous Kirschner wire fixation.
METHODS: Implement surgical treatment on 90 children having distal epiphyseal fractures of radius with no cut by minimally invasive closure and reduction of epiphyseal fractures. Two treatment methods were used: in control group, external fixation of only across carpal joint, external fixation of across carpal joint and percutaneous Kirschner wire fixation were used in the observation group. All cases were followed up at 9 weeks and 24 months after fixation. The long-dated clinical curative effects after surgical operation, functional recovery and the change of X-ray films were compared.
RESULTS AND CONCLUSION: According to Cooney rating criteria, the good to excellent rate of the control group was 77%. According to X-ray evaluation, the good to excellent rate was 63.33%. The good to excellent rate of the observation group was 93% and 90 % according to Cooney rating criteria and X-ray evaluation. The difference was significant between two groups (P < 0.01). All the cases got the clinical healing of bones and recovery of wrist joint function. Studies show that: In the minimally invasive surgical treatment of unstable distal epiphyseal fracture of radius with the combination of external fixation and reduction and percutaneous Kirschner wire fixation, K-wire helps the reduction with appropriate palmar inclination and ulnar deviation. Cured by external fixation, static fixation of fractures with the help of K-wire and dynamic transarticular fixation, the patients have a simple postoperative treatment with reliable fixation, good shape, fair recovery of function and few complications of epiphysis malunion. The basic learning function returns to normal after surgical treatment and the curative effects are stable and satisfactory.

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