Zhang Fu-Yong, Wang Xiao-Dong, Zhen Yun-Fang, Guo Zhi-Xiong, Dai Jin, Zhu Lun-Qing
From the Department of Orthopaedics, Children's Hospital of Soochow University, Suzhou, China.
Medicine (Baltimore). 2016 Jan;95(1):e2346. doi: 10.1097/MD.0000000000002346.
To evaluate the efficacy and safety of percutaneous K-wire leverage (PKWL) reduction and closed intramedullary pinning (CIMP) for the treatment of pediatric radial neck fractures. From June 2010 to December 2013, a total of 50 children with Judet III and IV radial neck fractures were treated at our hospital. Manual closed reduction was first attempted to reduce the radial neck fractures. Upon successful closed reduction or the radial neck-shaft angle was reduced to <45°, radial intramedullary pinning or CIMP was performed for fixation. Unsuccessful manual reduction was corrected using percutaneous K-wire leverage and CIMP. The injured arm was fixed at the functional position using plaster for 4 to 6 weeks. Sixteen patients were treated with manual closed reduction and CIMP (group A). Percutaneous K-wire leverage and CIMP were performed for 30 patients (group B). Another 4 patients were treated with open reduction and CIMP (group C). Groups B and C showed no significant difference in the radial neck-shaft angle, fracture displacement, and angle/displace ratio (P > 0.05), but were significantly larger than group A in the radial neck-shaft angle and fracture displacement (P < 0.05). Group A and B had significantly shorter operation time than group C (58.4 ± 14.5 minutes, 55.2 ± 11.2 minutes, versus 81.4 ± 7.5 minutes, P < 0.05). Forty-five patients were followed up for a mean of 2 years. Bone union was achieved in all patients within a mean time of 4.1 months. The patients treated with manual reduction or percutaneous leverage reduction showed excellent results. Three patients, however, treated with open reduction showed 10 to 20° limitation in range of motion of the elbow. No other complications were seen. Percutaneous K-wire leverage and CIMP are safe and effective for the treatment of pediatric Judet III and IV radial neck fractures.
评估经皮克氏针撬拨复位（PKWL）联合闭合髓内针固定（CIMP）治疗小儿桡骨颈骨折的疗效及安全性。2010年6月至2013年12月，我院共收治50例Judet III型和IV型桡骨颈骨折患儿。首先尝试手法闭合复位桡骨颈骨折。闭合复位成功或桡骨颈干角减小至<45°后，行桡骨髓内针固定或CIMP固定。手法复位失败则采用经皮克氏针撬拨复位及CIMP进行纠正。伤肢用石膏固定于功能位4至6周。16例患者采用手法闭合复位及CIMP治疗（A组）。30例患者采用经皮克氏针撬拨复位及CIMP治疗（B组）。另外4例患者采用切开复位及CIMP治疗（C组）。B组和C组在桡骨颈干角、骨折移位及角/移位比值方面差异无统计学意义（P>0.05），但在桡骨颈干角和骨折移位方面显著大于A组（P<0.05）。A组和B组的手术时间显著短于C组（分别为58.4±14.5分钟、55.2±11.2分钟，对比81.4±7.5分钟，P<0.05）。45例患者平均随访2年。所有患者均在平均4.1个月时实现骨愈合。手法复位或经皮撬拨复位治疗的患者效果良好。然而，3例切开复位治疗的患者肘关节活动范围受限10至20°。未见其他并发症。经皮克氏针撬拨复位及CIMP治疗小儿Judet III型和IV型桡骨颈骨折安全有效。
