2 种手术方法治疗儿童盖氏骨折的对比研究

Comparison of two operation methods in the treatment of child Galeazzi fracture

摘要:

目的：对比钢板与克氏针内固定2种手术方法治疗保守治疗失败的儿童盖氏骨折的可行性。方法：本组51例分别采用切开复位钢板内固定及克氏针内固定2种方法治疗桡骨骨折，手法复位下尺桡关节解剖关系或尺骨远端骺骨折，根据其稳定性决定是否以克氏针经皮固定尺骨远端骨骺或下尺桡关节，并置屈肘位长臂石膏托外固定4～6周。结果：2组所有病例均获得随访，平均随访15.6个月。根据Berton评分标准，钢板组28例：优9例，良17例，可2例，差0例，优良率92.9%。克氏针组23例：优5例，良9例，可7例，差2例，优良率达60.9%。差异有统计学意义（Ｐ＝0.034）。结论：对比克氏针内固定治疗方法，桡骨骨折采用钢板内固定结合长臂石膏托外固定治疗保守治疗失败儿童盖氏骨折可以获得更佳的骨折稳定性及腕和前臂功能。

Abstract:

Objective：To compare the feasibilities of two operation methods of internal fixation with steel plate and Kirschner wire in the treatment of child Galeazzi fracture with conservative treatment failure. Methods：Fracture of radius in 51 cases was treated with steel plate internal fixation and Kirschner wire internal fixation after open reduction. Anatomic relationship of distal radioulnar joint or distal ulna bone epiphysis fracture was treated with manual reduction. Whether to adopt Kirschner wire to fix distal ulna bone epiph－ysis or distal radioulnar joint was decided based on the its stability，and external fixation by long arm plaster support in the elbow flex－ion was adopted for 4 to 6 weeks. Results：All cases in two groups were followed up with an average period of 15.6 months. Accord－ing to Berton evaluation，among the 28 cases in steel plate group，there were 9 excellent cases，17 good cases，2 middle cases and 0 poor case，with an effective and good rate of 92.9%. Among 23 cases in Galeazzi group，there were 5 excellent cases，9 good cases，7 middle cases and 2 poor cases with an effective and good rate of 60.9%. Statistical significant differences were observed between two groups（P=0.034）. Conclusion：Internal fixation with Kirschner wire combined with external fixation by long arm plaster support can achieve better fracture stability and better function of wrist and forearm in the treatment of child Galeazzi fracture with conservative treatment failure.