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目的:探讨弹性髓内钉治疗儿童前臂双骨折术后出现尺骨延迟愈合及不愈合的可能原因。方法:2005年2月至2010年2月,对弹性髓内钉治疗闭合性儿童前臂双骨折术后出现骨延迟愈合或不愈合5例患者进行回顾性分析,均为男性;年龄3~14岁,平均9.4岁;骨折均累及尺桡骨干中1/3,其中2例患者既往曾有相同部位骨折史。高能量损伤3例,摔伤2例。其中4例患者予行切开复位,1例行闭合复位。观察患者术后并发症,并采用Daruwalla及Price评定标准进行疗效评价。结果:5例患者均获得随访,时间7~19个月,平均11.4个月。4例出现尺骨延迟愈合,1例出现不愈合。其中3例单纯取出内固定继续保守治疗,2例予更换固定方式继续治疗,所有骨折达到骨性愈合,未发生钉道感染或皮肤激惹等并发症。根据Daruwalla及Price评定标准,优3例,良2例。结论:弹性髓内钉治疗儿童前臂双骨折是一种很好的方法,但是进行该手术时需严格遵循手术操作规范,把握适应证,同时需要根据具体病例情况,有选择地应用,避免术后出现骨折延迟愈合或不愈合。
Objective: To investigate the possible causes of delayed union and ununion of ulna after elastic interlocking intramedullary nailing in children with double forearm fractures. Methods: From February 2005 to February 2010, 5 patients with delayed union or nonunion after closed reduction of bilateral forearm fracture treated with elastic intramedullary nails were retrospectively analyzed. All patients were male, aged 3-14 years , An average of 9.4 years old; fractures are involved in the radius and ulna in 1/3, of which 2 patients had the same history of previous fracture. High energy damage in 3 cases, fall in 2 cases. Four patients underwent open reduction and one closed reduction. The postoperative complications were observed and evaluated by Daruwalla and Price criteria. Results: All 5 patients were followed up for 7-19 months with an average of 11.4 months. Four cases showed ulnar delayed union, and one case showed nonunion. Among them, 3 cases were treated by simple conservative removal of internal fixation and 2 cases were treated by replacement and fixation. All the fractures reached the bony union without complications such as pin tract infection or skin irritation. According to Daruwalla and Price evaluation criteria, excellent in 3 cases, good in 2 cases. CONCLUSIONS: Elastic intramedullary nailing is a good method for the treatment of double forearm fracture in children. However, it is necessary to strictly follow the operation rules and indications while performing this operation. At the same time, it needs to be selectively applied according to the specific case to avoid postoperative Delayed or delayed fracture healing.