电邮这篇文章 儿童远节指骨撕脱性骨折手术治疗方法的分析
- 作者: Gordienko I.I.1,2, Slukina A.E.1, Tsap N.A.1,2
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隶属关系:
- Ural State Medical University
- Children’s City Clinical Hospital No. 9, Yekaterinburg
- 期: 卷 13, 编号 3 (2025)
- 页面: 247-255
- 栏目: Clinical studies
- URL: https://bakhtiniada.ru/turner/article/view/349946
- DOI: https://doi.org/10.17816/PTORS683118
- EDN: https://elibrary.ru/FMXDGR
- ID: 349946
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论证。撕脱性关节内骨折约占儿童远节指骨损伤的18%。截至目前，针对这类损伤的外科治疗尚无统一的途径。作为开放复位的替代方法，Ishiguro技术具有潜在优势，但其在儿童创伤学中的应用经验仍然有限。
目的：通过对比分析开放复位伴外周骨片克氏针固定与Ishiguro技术下的微创复位及骨接合效果，确定儿童远节指骨关节内撕脱性骨折的最佳外科治疗方案。
方法。在Children’s City Clinical Hospital No. 9创伤科第1和第2部门开展前瞻性队列研究，地点为Yekaterinburg。纳入29名儿童，均为关节面移位超过1/3的远节指骨关节内撕脱性骨折患者。研究组（n=15）采用Ishiguro微创复位与骨接合方法；对照组（n=14）采用开放复位与克氏针固定外周骨片。术后第3天和第7天对针道局部炎症反应进行宏观评估。去除内固定后第 1、2、4 周使用量角器测量远端指间关节活动度。
结果。研究组远端指间关节活动度恢复显著优于对照组：去除内固定后1周分别为17.80±7.43°vs 7.79±3.40°（p<0.001）；2周为 57.47±13.11° vs 28.86±12.09°（p<0.001）；4周为89 [85; 90]° vs 78.50 [77.25; 83.00]°（p<0.001）。在术后第3天和第7天对钢针植入部位进行宏观评估时，两组在针道局部炎症反应方面未见统计学差异（p>0.05）。所有病例均实现骨折愈合。对照组1例出现外周骨片碎裂的不良事件。
结论。Ishiguro骨接合技术具有良好的技术可重复性、微创性和优良的功能恢复效果，可推荐作为儿童远节指骨关节内撕脱性骨折的首选治疗方法。
作者简介
Ivan I. Gordienko
Ural State Medical University; Children’s City Clinical Hospital No. 9, Yekaterinburg
编辑信件的主要联系方式.
Email: ivan-gordienko@mail.ru
ORCID iD: 0000-0003-3157-4579
SPIN 代码: 5368-0964
MD, Cand. Sci. (Medicine), Assistant Professor
俄罗斯联邦, Yekaterinburg; YekaterinburgAnastasia E. Slukina
Ural State Medical University
Email: anast.slukina@gmail.com
ORCID iD: 0009-0000-3431-7813
SPIN 代码: 5149-4840
俄罗斯联邦, Yekaterinburg
Natalia A. Tsap
Ural State Medical University; Children’s City Clinical Hospital No. 9, Yekaterinburg
Email: tsapna-ekat@rambler.ru
ORCID iD: 0000-0001-9050-3629
SPIN 代码: 7466-8731
MD, Dr. Sci. (Medicine), Professor, Honored Doctor of the Russian Federation
俄罗斯联邦, Ekaterinburg; Ekaterinburg参考
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Fig. 1. X-ray of a 14-year-old child with an avulsion fracture of the base of the nail phalanx (mallet fracture) of the third finger of the right hand with displacement.
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Fig. 2. Surgical treatment diagram using open reduction and osteosynthesis of the peripheral fragment: 1 — pin fixing the peripheral fragment; 2 — pin fixing the phalanges of the fingers in a position of decreased flexor tone.
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Fig. 3. Surgical treatment stages using the Ishiguro method: a — flexion of the distal phalanx and insertion of a Kirschner wire into the middle phalanx above the peripheral fragment; b — extension of the distal phalanx and reposition of the fragment; c — transarticular fixation of the distal interphalangeal joint in an extension position; d — appearance of the finger at the end of the surgery.
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Fig. 4. Indicators of range of motion in the distal interphalangeal joint in patients of the main and control groups: DIPJ - distal interphalangeal joint.
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