不同类型克氏针固定治疗儿童闭合性移位指骨颈骨折的临床疗效：一项回顾性观察研究。

Clinical outcomes of closed, displaced phalangeal neck fractures in children with different types of kirschner wire fixation: A retrospective observational study.

作者信息

Wu Chunxing, Song Jun, Ning Bo, Mo Yueqiang, Wang Dahui

机构信息

Department of Pediatric Orthopaedics, Children's Hospital of Fudan University, & National Children's Medical Center, Shanghai, China.

出版信息

Front Pediatr. 2023 Feb 27;11:1039415. doi: 10.3389/fped.2023.1039415. eCollection 2023.

DOI:10.3389/fped.2023.1039415

PMID:36911019

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10002975/

Abstract

OBJECTIVES

Inappropriate treatment of Closed displaced phalangeal neck fractures (CDPNF) in children usually leads to poor outcomes.This study was to evaluate the clinical outcomes of closed/open reduction, age, and different types of fracture and Kirschner wire (K-wire) fixation in the treatment of CDPNF.

MATERIALS AND METHODS

Participants: Sixty patients (male, 46 and female,14; right-handed, 35 and left-handed, 25; mean age, 7.9-years-old [range, 1.0-14.5 years]) who had CDPNF were included. Preoperative x-rays showed that the fractures were displaced and exhibited obvious deformities. : First, reduction (four cases of open reduction and 56 cases of closed reduction) was performed followed by percutaneous K-wire fixation (cross fixation, 24 cases; longitudinal and slanting fixation, 17 cases; homolateral fixation, four cases; and single longitudinal fixation, 15 cases,) and immobilized by cast. x-ray examination following removal of the K-wires showed that the fractures were healed; the criteria for fracture healing were callus formation and the absence of fracture lines. Clinical outcome and radiographs between groups were compared.

RESULTS

According to the visual analogue scale, the pain scores were excellent. According to the Al-Qattan Grade system(AGS),all the patients presented with closed, type II phalangeal neck fractures,the results were excellent in 36 cases (36/60, 60%), good in 15 cases (15/60, 25%), fair in 5 cases (5/60, 8.3%) and poor in 4 cases (4/60, 6.7%). There were significant differences in different fracture type groups ( = 0.013*), operation age groups ( = 0.025*) and open/closed reduction groups ( = 0.042*). There was no significant difference in K-wire fixation type groups ( > 0.05).

CONCLUSIONS

Patients with open reduction, the more serious fracture type, the older at the operation, were more likely to have poor AGS result. Different K-wire fixation types for CDPNF in children had the same satisfactory results.

摘要

目的

儿童闭合性移位指骨颈骨折（CDPNF）治疗不当通常会导致不良后果。本研究旨在评估闭合/切开复位、年龄、不同骨折类型以及克氏针（K 针）固定治疗 CDPNF 的临床效果。

材料与方法

参与者：纳入 60 例患有 CDPNF 的患者（男性 46 例，女性 14 例；右利手 35 例，左利手 25 例；平均年龄 7.9 岁[范围 1.0 - 14.5 岁]）。术前 X 光显示骨折有移位且存在明显畸形。首先进行复位（4 例切开复位和 56 例闭合复位），随后行克氏针经皮固定（交叉固定 24 例；纵斜固定 17 例；同侧固定 4 例；单纵固定 15 例），并用石膏固定。克氏针取出后的 X 光检查显示骨折愈合；骨折愈合标准为骨痂形成且无骨折线。比较各治疗组间的临床效果和 X 光片表现。

结果

根据视觉模拟评分法，疼痛评分优良。根据阿尔 - 卡坦分级系统（AGS），所有患者均为闭合性Ⅱ型指骨颈骨折，结果优 36 例（36/60，60%），良 15 例（15/60，25%），可 5 例（5/60，8.3%），差 4 例（4/60，6.7%）。不同骨折类型组（P = 0.013*）、手术年龄组（P = 0.025*）和切开/闭合复位组（P = 0.042*）存在显著差异。克氏针固定类型组无显著差异（P > 0.05）。