Meier Reinhard, Prommersberger Karl-Josef, van Griensven Martijn, Lanz Ulrich
Unfallchirurgische Klinik, Medizinische Hochschule Hannover, 30625 Hannover, Germany.
Arch Orthop Trauma Surg. 2004 Jan;124(1):1-9. doi: 10.1007/s00402-003-0585-x. Epub 2003 Sep 30.
The indication and treatment of malunited fractures of the distal radius in the growing skeleton differ from those for adults. The literature results are scarce. In this study we examined the results of surgical correction following fractures of the distal radius in infants.
Seven infant patients with malaligned fractures of the distal radius that demonstrated significant functional deficit and poor prognosis for spontaneous recovery were treated with surgical correction. Two of them were treated because of growth disturbance from post-traumatic closure of the distal radial physis.
All seven osteotomies healed with acceptable radiologic alignment. After an average follow-up period of 3 years and 1 month (range 10 months to 8 years and 4 months), patients had an average range of wrist motion (ROM) of 131 deg in extension and flexion (93% of the contralateral side, 130% of presurgical situation); 65 deg in ulnar and radial deviation (94% of the contralateral side, 122% of presurgical situation); and 177 deg in pronation and supination of the forearm (97% of the contralateral side, 115% of presurgical situation). The average grip strength of 71.4 kPa was nearly equal to the other side with 72.8 kPa. The average postoperative angulation of the distal radius was 12 (range 10-17) deg, the radial inclination 20 (range 12-30) deg, and the ulnar variance was -0.6 (range -3 to +2) mm. According to the Fernandez point score system as well as the scale of Fernandez, there were five excellent results and two good results. The patients described low disability on the DASH scores, with a median of 4 (range 0-41) points.
Surgical correction for malunited fractures of the distal radius provides good and excellent radiological and functional results in the growing skeleton. It should be considered immediately if there is poor remodeling capacity and disabling loss of function.
儿童桡骨远端骨折畸形愈合的适应证和治疗方法与成人不同。相关文献报道较少。在本研究中，我们观察了婴儿桡骨远端骨折手术矫正的效果。
7例桡骨远端骨折畸形愈合且功能明显受限、自发恢复预后不佳的婴儿患者接受了手术矫正治疗。其中2例因创伤后桡骨远端骨骺闭合导致生长障碍而接受治疗。
所有7例截骨均获得了可接受的放射学对线愈合。平均随访3年1个月（范围10个月至8年4个月），患者腕关节屈伸平均活动度（ROM）为131°（对侧的93%，术前的130%）；尺桡偏平均活动度为65°（对侧的94%，术前的122%）；前臂旋前旋后平均活动度为177°（对侧的97%，术前的115%）。平均握力为71.4 kPa，与对侧的72.8 kPa几乎相等。术后桡骨远端平均成角为12°（范围10° - 17°），桡骨倾斜度为20°（范围12° - 30°），尺骨变异为 -0.6 mm（范围 -3至 +2 mm）。根据费尔南德斯评分系统及费尔南德斯量表评估，结果为5例优，2例良。患者DASH评分显示残疾程度较低，中位数为4分（范围0 - 41分）。
桡骨远端骨折畸形愈合的手术矫正为儿童骨骼提供了良好及优异的放射学和功能结果。如果重塑能力差且功能丧失致残，应立即考虑手术矫正。
