Cullen M C, Roy D R, Giza E, Crawford A H
Department of Orthopaedic Surgery, Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Pediatr Orthop. 1998 Jan-Feb;18(1):14-21.
A retrospective review of 20 children with forearm fractures treated with intramedullary fixation is presented. Indications for surgery included fracture malreduction, open fracture, polytrauma, unstable fracture pattern, and compartment syndrome. Both radius and ulna were fractured in patients. Intramedullary fixation of both bones was performed in eight cases, ulna alone in nine, and isolated radius in three. A limited open approach to one or both bones was necessary for insertion of the intramedullary rod in 15 of 20 cases, including the eight open fractures. Eighteen complications occurred in 10 of 20 patients, including hardware migration, infection, loss of reduction, reoperation, nerve injury, significant decreased range of motion, synostosis, muscle entrapment, and delayed union. Despite the complications, 17 patients had excellent and two had good outcomes. Although excellent clinical results can be expected with intramedullary fixation, complications related to the surgical technique can be expected.
本文对20例采用髓内固定治疗的儿童前臂骨折进行了回顾性研究。手术指征包括骨折复位不良、开放性骨折、多发伤、不稳定骨折类型以及骨筋膜室综合征。所有患者均为桡骨和尺骨双骨折。20例患者中，8例行双骨髓内固定，9例仅行尺骨髓内固定，3例仅行桡骨髓内固定。20例中有15例（包括8例开放性骨折）在插入髓内钉时需要对一根或两根骨头采用有限切开入路。20例患者中有10例出现了18种并发症，包括内固定物移位、感染、复位丢失、再次手术、神经损伤、活动范围显著减小、骨桥形成、肌肉嵌顿以及延迟愈合。尽管出现了并发症，但17例患者预后极佳，2例患者预后良好。虽然髓内固定有望获得优异的临床效果，但与手术技术相关的并发症仍有可能发生。
