儿童尺桡骨远端干骺端骨折继发移位及再次手术的预防
Prevention of secondary displacement and reoperation of distal metaphyseal forearm fractures in children.
作者信息
van Delft Eva A K, Vermeulen Jefrey, Schep Niels W L, van Stralen Karlijn J, van der Bij Gerben J
机构信息
Amsterdam UMC, Vrije Universiteit Amsterdam Department of Trauma Surgery, Amsterdam Movement Sciences, Spaarne Gasthuis, Department of Trauma Surgery Boelelaan 1117, Amsterdam, The Netherlands Boerhaavelaan 22, 2035RC, Haarlem, the Netherlands.
Trauma Surgeon, Maasstad Hospital, Department of Trauma Surgery, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands.
出版信息
J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S817-S822. doi: 10.1016/j.jcot.2020.07.016. Epub 2020 Jul 31.
BACKGROUND
Metaphyseal distal forearm fractures are common in paediatric patients and treating these fractures by reduction and cast immobilization alone is under debate, since secondary displacement is a frequent complication that often warrants re-intervention. This study was conducted to invest the incidence of secondary displacement and re-intervention for non-displaced and displaced fractures, with or without fixation.
MATERIAL AND METHODS
A retrospective cohort study was conducted analysing all consecutive paediatric patients under the age of 16 with distal metaphyseal forearm fractures throughout a 2-year period. Data were recorded on radiographic characteristics, OTC/AO-classification, type of treatment, reduction technique, surgical interventions and removal of hardware and complications.
RESULTS
200 Patients with displaced metaphyseal forearm fractures were included of which 139 were primarily treated in the emergency room, the other 61 patients were primarily treated in the operating room. 83% Of the patients had a satisfactory reduction in the emergency room and 94% of these patients were treated successfully with casting alone. A total of 84 patients were treated in the operating room of whom 30% underwent reduction and K-wire fixation, and 70% underwent reduction and casting only. 47% Of the patients treated with closed reduction without K-wire fixation in the operating room suffered from secondary displacement, of which 80% needed re-intervention.
CONCLUSION
Metaphyseal forearm fractures can be treated with a very high success rate by closed reduction and casting alone in the emergency room. Reduction and casting of displaced metaphyseal forearm fractures in children that needed treatment in the operating room however, resulted in unacceptable high rate of secondary displacement and commonly required re-intervention. Those patients should therefore be treated by reduction and K-wire fixation.
背景
小儿患者中尺桡骨远端干骺端骨折很常见，仅通过复位和石膏固定来治疗这些骨折存在争议，因为二次移位是一种常见并发症，常常需要再次干预。本研究旨在调查非移位和移位骨折无论有无固定情况下的二次移位发生率及再次干预情况。
材料与方法
进行一项回顾性队列研究，分析连续2年中所有16岁以下尺桡骨远端干骺端骨折的小儿患者。记录影像学特征、OTC/AO分类、治疗类型、复位技术、手术干预、内固定取出及并发症等数据。
结果
纳入200例尺桡骨远端干骺端移位骨折患者，其中139例最初在急诊室接受治疗，另外61例最初在手术室接受治疗。83%的患者在急诊室获得满意复位，其中94%的患者仅通过石膏固定成功治疗。共有84例患者在手术室接受治疗，其中30%进行了复位和克氏针固定，70%仅进行了复位和石膏固定。在手术室接受闭合复位但未行克氏针固定的患者中，47%发生了二次移位，其中80%需要再次干预。
结论
尺桡骨远端干骺端骨折在急诊室仅通过闭合复位和石膏固定即可获得很高的成功率。然而，对于需要在手术室治疗的小儿尺桡骨远端干骺端移位骨折，复位和石膏固定导致不可接受的高二次移位率，通常需要再次干预。因此，这些患者应采用复位和克氏针固定治疗。
Zotero 插件