抓住那个K电线! 在儿科浮动肘部损伤中修复非移位的远端前臂骨折是不必要的
Maia D Regan1, Akbar Syed1, Keith D Baldwin1
1Orthopaedic Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Journal of the Pediatric Orthopaedic Society of North America
|November 10, 2025
概括
对于儿科浮动肘部损伤,非移位远部前臂骨折的手术固定显示了与非手术治疗相似的结果. 早期恢复活动在非手术治疗中更高,但并发症和重新手术率相似.
科学领域:
- 儿科整形外科 儿科整形外科
- 儿科创伤 儿童创伤
- 儿科 上肢伤害 儿童上肢伤害
背景情况:
- 在儿童中,浮动肘部损伤,骨骨折和远端前臂骨折的组合是不常见的.
- 从历史上看,由于对急性隔间综合征的担忧,建议对远端前臂骨折进行积极的手术治疗.
- 最近的证据表明,隔间综合征的发病率很低,这挑战了侵略性手术干预的必要性.
研究的目的:
- 调查假设,在儿科浮动肘部损伤中,同时发生的非移位远端前臂骨折的手术固定与非手术治疗的结果类似.
- 为了比较功能恢复,并发症率和手术和非手术治疗间的重复手术率,在浮动肘部损伤中对远端前臂骨折进行治疗.
主要方法:
- 2014年至2019年间,对患有浮动肘部损伤的儿科患者进行了多中心的回顾性数据库分析 (骨骨折和非移位远端前臂骨折).
- 患者根据非移位远端前臂骨折的管理策略进行了分层:手术固定与非手术 (封闭) 治疗.
- 评估的结果包括恢复活动,修改的弗林标准,神经缺陷,恶性结合,隔间综合征和重新手术率.
主要成果:
- 在102名患者中,26人接受了手术固定. 根据超骨折的位移,没有观察到远端前臂骨折固定发生率的显著差异.
- 虽然固定组的手术时间较长,但非固定组的患者比例较高,恢复了早期的完全活动 (80% vs 68%).
- 在手术和非手术组之间,功能恢复 (修改的弗林标准),症状,神经缺陷,失联和重新手术率等结果在手术和非手术组之间相似. 没有报告出现隔间综合征或需要进行筋切除术.
结论:
- 在儿科浮动肘部损伤中,非手术治疗非移位远部前臂骨折,可以提高早期恢复全面活动的速度.
- 在这个队列中,手术固定非移位的远端前臂骨折不会导致与非手术治疗相比显著不同的功能结果,并发症率或重新手术率.
- 这些发现表明,在儿科浮动肘部损伤中,对非移位的远端前臂骨折采取积极的手术方法可能并不普遍,封闭治疗是可行的选择.
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