Sun Jianhua, Zhang Xinhu, Zhou Lianjun, Fan Qiushen, Liu Bin
The Third Department of Orthopaedics, the Harrison International Peace Hospital, Hengshui Hebei, 053000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Jun;26(6):661-5.
To analyze and compare the effectiveness of the closed reduction with elastic intramedullary nailing and open reduction with Kirschner wire fixations in the treatment of O'Brien type III radial neck fractures in children.
Between November 2007 and November 2010, 31 children with O'Brien type III radial neck fractures were treated by the closed reduction with elastic intramedullary nailing fixation (closed reduction group, n=18) and by the open reduction with Kirschner wire fixation (open reduction group, n=13). There was no significant difference in age, gender, disease duration, and fracture classification between 2 groups (P > 0.05).
The incisions of 2 groups healed primarily. All the patients were followed up 1-2 years (mean, 1.5 years). Limitation of the elbow extension occurred in 2 cases of the closed reduction group, limitations of the elbow extension, flexion, and forearm pronation in 6 cases of the open reduction group. There was no significant difference in elbow flexion, extension, pronation, and supination between affected side and normal side in the closed reduction group (P > 0.05). Except in supination (P > 0.05), there were significant differences in flexion, extension, and pronation between affected side and normal side in the open reduction group (P < 0.05). According to Metaizeau's grading criterion, excellent results were achieved in 16 cases and good in 2 cases in the closed reduction group; excellent results were achieved in 4 cases, good in 4 cases, fair in 3 cases, and poor in 2 case in the open reduction group; and there was significant difference between 2 groups (Z=3.435, P=0.001). The X-ray films showed anatomical reduction in 2 groups before removal of internal fixation; redisplacement occurred in 4 cases after removal of internal fixation in the open reduction group, no redisplacement occurred in the closed reduction group. There was no avascular necrosis of radial head and epiphyses during follow-up.
Comparison with the open reduction with Kirschner wire fixation, the closed reduction with elastic intramedullary nailing fixation is a reliable and good treatment for O'Brien type III radial neck fractures in children, because it has the advantages of minimal invasion, easy operation, stable fixation, early mobilization, and less complication.
分析比较弹性髓内针闭合复位与克氏针切开复位固定治疗儿童奥布赖恩III型桡骨颈骨折的疗效。
2007年11月至2010年11月，31例儿童奥布赖恩III型桡骨颈骨折患者，采用弹性髓内针闭合复位固定治疗（闭合复位组，n = 18）和克氏针切开复位固定治疗（切开复位组，n = 13）。两组患者在年龄、性别、病程及骨折分型方面差异无统计学意义（P > 0.05）。
两组切口均一期愈合。所有患者均获随访1 - 2年（平均1.5年）。闭合复位组2例出现肘关节伸直受限，切开复位组6例出现肘关节伸直、屈曲及前臂旋前受限。闭合复位组患侧与健侧肘关节屈伸、旋前、旋后活动度差异无统计学意义（P > 0.05）。切开复位组除旋后活动度外（P > 0.05），患侧与健侧肘关节屈伸、旋前活动度差异有统计学意义（P < 0.05）。根据梅泰佐分级标准，闭合复位组优16例，良2例；切开复位组优4例，良4例，可3例，差2例；两组比较差异有统计学意义（Z = 3.435，P = 0.001）。两组内固定取出前X线片均显示骨折解剖复位；切开复位组内固定取出后4例出现再移位，闭合复位组无再移位发生。随访期间无桡骨头及骨骺缺血性坏死发生。
与克氏针切开复位固定相比，弹性髓内针闭合复位固定治疗儿童奥布赖恩III型桡骨颈骨折具有创伤小、操作简便、固定稳定、可早期活动及并发症少等优点，是一种可靠的良好治疗方法。
