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[儿童桡骨颈骨折——“一种良性骨折?”]

[Radial neck fracture in children-"A benign fracture?"].

作者信息

Dietz Sven-Oliver, Schierjott Lotte, Loose Oliver, Gercek Erol, Fernandez Francisco

机构信息

Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55101, Mainz, Deutschland.

Orthopädische Klinik, Klinikum Stuttgart, Olgahospital, Stuttgart, Deutschland.

出版信息

Unfallchirurgie (Heidelb). 2024 Oct;127(10):697-704. doi: 10.1007/s00113-024-01475-5. Epub 2024 Sep 13.

DOI:10.1007/s00113-024-01475-5
PMID:39269495
Abstract

Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of 8 and 12 years old are more frequently affected, whereby a cubitus valgus variant can be a predisposing factor. The main trauma mechanism is a fall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X‑radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while a surgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using a elastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires a comprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions.

摘要

儿童桡骨颈骨折虽罕见,但属临床相关损伤,常伴有其他合并伤。8至12岁的女孩更易受影响,肘外翻变异可能是一个诱发因素。主要创伤机制是伸直、旋后位的手臂着地并伴有额外的外翻应力。桡骨颈骨折可能伴有肘关节的合并伤,包括鹰嘴骨折和肘关节脱位。诊断通常通过传统X线片进行,不过对于年幼患儿,超声检查也可能适用。治疗取决于骨折脱位情况。如果近端骨折块成角小于20°,任何年龄都肯定可以采用保守治疗,而对于较大的脱位,可根据年龄考虑手术干预。按照梅塔佐的方法,使用弹性稳定髓内钉(ESIN)进行闭合复位内固定已成为标准术式。可能会出现诸如骨骺过早闭合、关节融合、缺血性坏死、假关节形成以及桡骨头变形等并发症,这些会影响功能预后。此类并发症的治疗通常需要综合多学科方法,可能包括保守和手术措施。长期研究表明,大多数桡骨颈骨折患儿预后良好至非常好,尽管某些预测因素与较差的预后相关。了解潜在并发症及其治疗方法对于成功处理儿童桡骨颈骨折至关重要,在做出临床决策时应予以考虑。

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1
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本文引用的文献

1
Fractures of the proximal radius in children: management and results of 100 consecutive cases.儿童桡骨近端骨折:100 例连续病例的治疗和结果。
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Prognostic factors for intramedullary nailing in radial neck fracture in children.儿童桡骨颈骨折髓内钉治疗的预后因素。
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儿童桡骨颈骨折的治疗原则、预后因素及争议:一项系统评价
J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S456-S463. doi: 10.1016/j.jcot.2020.04.022. Epub 2020 Apr 26.
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Management of Severely Displaced Radial Neck Fractures in Children: A Systematic Review and Meta-analysis of Outcomes.儿童严重移位桡骨颈骨折的治疗:结局的系统评价与荟萃分析
Indian J Orthop. 2020 Jan 24;54(1):60-68. doi: 10.1007/s43465-019-00032-2. eCollection 2020 Feb.
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Acquired Upper Extremity Growth Arrest.获得性上肢生长停滞
Orthopedics. 2017 Jan 1;40(1):e95-e103. doi: 10.3928/01477447-20160926-07. Epub 2016 Sep 30.
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Judet type-IV radial neck fractures in children: Comparison of the outcome of fractures with and without bony contact.儿童Judet IV型桡骨颈骨折:有与无骨接触骨折的疗效比较
Acta Orthop. 2016 Oct;87(5):529-32. doi: 10.1080/17453674.2016.1203700. Epub 2016 Jun 27.
7
Surgical Techniques for Displaced Radial Neck Fractures: Predictive Factors of Functional Results.桡骨颈骨折移位的手术技术:功能结果的预测因素
J Pediatr Orthop. 2017 Apr/May;37(3):159-165. doi: 10.1097/BPO.0000000000000617.
8
Predisposing Effect of Elbow Alignment on the Elbow Fracture Type in Children.肘部对线对儿童肘部骨折类型的 predisposing 作用。 注:“predisposing”这个词在这里可能不太好直接准确翻译,结合语境大概是指一种“前置影响、诱发倾向”之类的意思,但按照要求保留英文未翻译。
J Orthop Trauma. 2015 Aug;29(8):e253-8. doi: 10.1097/BOT.0000000000000322.
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[Growth behaviour after fractures of the proximal radius: differences to the rest of the skeleton].
Unfallchirurg. 2014 Dec;117(12):1085-91. doi: 10.1007/s00113-014-2632-1.
10
Management of posttraumatic radioulnar synostosis.创伤后尺桡骨骨化性肌炎的治疗。
J Am Acad Orthop Surg. 2012 Jul;20(7):450-8. doi: 10.5435/JAAOS-20-07-450.