经皮横向克氏针固定治疗儿童桡骨远端干骺交界区骨折

作者	单位	邮编
万志宏^*	西南医科大学附属医院小儿外科,四川泸州,646000	646000
梁皓	西南医科大学附属医院小儿外科,四川泸州,646000	646000
马瑞	西南医科大学附属医院小儿外科,四川泸州,646000	646000
贺智榆	西南医科大学附属中医医院骨伤科,四川泸州,646000 西南医科大学附属中医医院儿童骨科,四川泸州,646000	646000
陈孝均^*	西南医科大学附属中医医院骨伤科,四川泸州,646000 西南医科大学附属中医医院儿童骨科,四川泸州,646000	646000

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中文摘要:

目的评价闭合复位经皮横向克氏针固定治疗儿童桡骨远端干骺交界区（diametaphysis, DMP）骨折的临床疗效。方法回顾性分析自2023年1月至2024年12月西南医科大学附属中医医院采用闭合复位经皮横向克氏针固定治疗的22例儿童桡骨远端DMP骨折。其中，男15例，女7例；年龄6.5～13.2岁，平均（9.3±2.8）岁；术中先行手法闭合复位，部分复位困难的患儿需联合经皮克氏针撬拨辅助复位。尺桡骨双骨折患儿先行尺骨顺行髓内克氏针固定。针对桡骨远端DMP骨折，前臂中立位，采用冠状面经皮横向3枚克氏针固定，将桡骨骨折近、远端分别固定于尺骨上。术后长臂管型石膏制动3周后换为前臂管型石膏固定3周。定期随访观察患儿骨折愈合情况，正、侧位骨折成角情况及并发症。骨痂连续性通过骨折断端时，门诊拔除克氏针。末次随访时，采用Gartland-Werley腕关节功能评分系统对腕关节进行功能评价。结果 22例均顺利完成手术并获得完整随访，随访时间6～12个月，平均（8.7±2.1）个月。所有病例均完成闭合复位，其中4例单纯手法复位，18例经皮克氏针撬拨辅助复位。骨折临床愈合时间为6～12周，平均（7.5±2.3）周。所有患儿术后无血管、神经及肌腱损伤，无骨折再移位、延迟愈合、不愈合、再骨折发生，无针道感染。术后3 d、末次随访时的正、侧位骨折成角与术前相比，差异均有统计学意义（P＜0.05）；末次随访时正、侧位骨折成角与术后3 d相比，差异无统计学意义（P＞0.05）。末次随访时，Gartland-Werley腕关节功能评分结果为优18例，良4例，优良率100%。结论闭合复位联合经皮横向克氏针固定治疗儿童桡骨远端DMP骨折具有操作简单、复位及固定满意、安全微创、不损伤骨骺、腕关节功能恢复好、并发症少、不需要二次手术等优点，可作为治疗该类型骨折的有效方案。

英文摘要:

Objective To evaluate the clinical efficacy of closed reduction and percutaneous transverse Kirschner wire fixation for the treatment of distal radial diametaphyseal (DMP) junction fractures in children.Methods A retrospective analysis was conducted on 22 cases of distal metaphyseal fractures of the radius in children, who were treated with closed reduction and percutaneous transverse Kirschner wire fixation in the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University from January 2023 to December 2024. The cohort included 15 males and 7 females, aged from 6.5 to 13.2 years (mean 9.3±2.8 years). During surgery, closed manual reduction was primarily performed; for cases with difficult reduction, percutaneous Kirschner wire prying was combined to assist reduction. For patients with combined radial and ulnar fractures, antegrade intramedullary Kirschner wire fixation of the ulna was performed first. For the distal radial DMP fracture, with the forearm in a neutral position, three percutaneous transverse Kirschner wires were inserted in the coronal plane to fix the proximal and distal fragments of the radial fracture to the ulna. Postoperatively, a long-arm cast was applied for immobilization for 3 weeks, followed by a forearm cast for an additional 3 weeks. Regular follow-ups were conducted to monitor fracture healing, fracture angulation on anteroposterior and lateral radiographs, and any complications. Kirschner wires were removed in the outpatient clinic when callus continuity bridged the fracture site. At the final follow-up, wrist function was assessed using the Gartland-Werley wrist scoring system.Results All 22 patients successfully underwent the procedure and completed the full follow-up period ranging from 6 to 12 months (mean 8.7±2.1 months). Closed reduction was achieved in all cases, including 4 cases managed with manual reduction alone and 18 cases requiring percutaneous Kirschner-wire-assisted reduction. The time to clinical fracture union was 6-12 weeks (mean 7.5±2.3 weeks). No complications were observed, including neurovascular or tendon injuries, fracture redisplacement, delayed union, nonunion, refracture, or pin tract infection. Significant differences were observed in the fracture angles on both anteroposterior and lateral radiographs at 3 days postoperatively and at the final follow-up compared to the preoperative measurements (P<0.05). However, no statistically significant difference was found in the fracture angles between the final follow-up and the measurements taken at 3 days postoperatively (P>0.05). At the final follow-up, the Gartland-Werley wrist score was excellent in 18 cases and good in 4 cases, yielding an excellent-good rate of 100%.Conclusion Closed reduction combined with percutaneous transverse Kirschner wire fixation for treating distal radial DMP fractures in children offers advantages including simple procedure, satisfactory reduction and fixation, safety and minimal invasiveness, avoidance of physeal injury, good recovery of wrist function, few complications, and no need for secondary surgery. It can be considered an effective treatment option for this fracture type.

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