微型外固定架治疗难复性儿童前臂远端骨折
Mini external fixation for refractory distal forearm fracture in children
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摘要: 目的 探讨微型外固定支架复位并固定难复性儿童前臂远端骨折的疗效,分析其优缺点。 方法 回顾性分析2009年8月-2011年12月解放军总医院小儿骨科采用单臂微型外固定架(Orthofix)复位并固定治疗难复性儿童前臂远端骨折16例,其中单纯闭合性骨折14例、开放性骨折2例,均为行手法复位、手法牵引复位或者克氏针撬拨复位失败后,采用C臂机透视下使用Orthofix微型外固定支架行牵张复位并固定。 结果 手术时间20-60min,平均36min,出血量均在5ml以下。2例在固定过程中出现I级针道感染,通过换药等手段处理后痊愈;固定过程中腕关节活动无受限,骨折愈合时间8-12周,平均10.1周。术后随访2-20个月,平均11.7个月,骨折全部骨性愈合。 结论 应用微型外固定架治疗难复性小儿前臂远端骨折,不破坏骨折断端血运、允许早期功能锻炼且不影响腕关节功能、后期骨折无再次移位、护理负担轻。Abstract: Objective To study the clinical outcomes of refractory distal forearm fractures in children after the mini external fixation and analyze its advantages and disadvantages. Methods clinical outcomes of refractory distal forearm fractures in 16 children(14 with close fractures and 2 with open fractures) after the mini external fixation were retrospectively analyzed.The patients underwent the mini external fixation(Orthofix) or Orthofix plus distracting reduction under local or general anesthesia after failure of manual and mental wire reduction. Results The operation time was 20-60 minutes(mean 36min).The blood loss was less than 5ml.Degree I infection occurred at the pin sites in 2 patients and was cured by changing dressings.No failure of external fixation occurred due to pin site infection.The bone healing time was 8-12 weeks(mean 10.1 weeks).The patients were followed up for 2-20months(11.7 months) after operation.Movement of wrist joint was not limited.Bony healing was achieved in all fractures. Conclusion The mini unilateral external fixation is effective for refractory distal forearm fractures with not disruption of the blood supply to the facture site,no limitation of early wrist joint functional excise,no concern about late displacement of the fractures,thus releasing nursing burden of parents nursery and mental load of children.